Post Covid physiotherapy management of Covid-19 patient.

Post covid rehabilitation of 55years old male patient with hrct 22/25. Patient started to get symptoms around 20/05 and developed sever respiratory distress on 25/05. He was admitted to hospital and was on oxygen support with a flow rate of around 25-30 ltr/hr. After 3-5 days he was referred to higher center as condition was deteriorating. But guardians refused to take him to higher center as they were scared of not being well taken care of there and instead took him to home at oxygen support with NRBM. When they bring him to home he was on around 25 ltr flow rate. Some where they came to know role of physiotherapy in Covid patients and contacted me on 10/06. After examining the condition of patient I insisted them to take him to higher center. But they refused and said either he will die here or survive here. We'll not take him to hospital any more. On 13/06 I started chest physiotherapy and asked them to repeat inflammatory markers along with RTPCR and chest xray. RTPCR was negative but some of the inflammatory markers were raised. Chest xray was indicating sever Covid pneumonitis. After 8-10 days of chest PT patient started to feel comfortable and oxygen requirement reduced to 10-12 ltr at day time and 6-7 ltr at night. On 24 /06 xray was repeated and attached here which shows much improvement. Oxygen requirement has reduced to 6-8 ltr at day time and 3-5 ltr at night. Physiotherapy treatment is continued along with all necessary medications. Hoping for more recovery. Role of physiotherapy is very crucial in Covid patients. My opinion is that it should be started in inactive phase of disease as there are more chances of spread rapidly in respiratory tract in active phase. What's your opinion ? Please give your valuable opinion.

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I have a similar patient who has been discharged after 25 days from hospital. After being off from O2 concentrator for 3 to 4 hours, her saturation falls to 84% She is on medrol 4mg OD along with Incentive Sprirometry exercise and diaphragmatic breathing exercise. Kindly guide me too regarding mine case @Rajesh Sharma Pt (Pt)

Spirometry exercise and diaphragmatic breathing exercises are not enough to restore O2 saturation to normal level in severally affected Covid-19 patients. Some of important things needs to be addressed.. 1. Rib mobility 2. Pleural mobility 3. Spinal mobility 4. Full diaphragmatic excursion 5. Postural drainage of all the affected segments of lungs 6. Exertion of accessory respiratory muscles Once all the above things are addressed properly then spirometry exercise along with all other respiratory exercise will be effective. This can be done only by a qualified physiotherapist who has expertise in manual therapy.
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Well-done .. You have taken risk and save the life . That's great .In whole second wave of Covid 19 pandamic risk factors were there .When risk was taken by both ends , Live saved . Once again congratulations

Thank you doctor
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Physiotherapy is definitely a role in rehabilitation but during acute red and grey hepatisation phage is questionable.physiotherapy can't suppress cytokine storm.

Yes you are right dr. That's why I have mentioned it should not be started in acute or active phase of disease. But we can't ignore it's magical role in post covid patients. I have seen in many setups that they are giving chest PT in acute phase which may deteriorate patients condition. When chest PT is given at the time of cytokinesis storm there are more chances to spread the infection from one lobe which is more severally affected to less affected lobes. so in my opinion once cytokine storm is suppressed and RTPCR is negative it should be started without any delay.
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Doctor I appreciate your efforts! and Yes there is really good Improvement... Few are the findings from the X-ray Pneumonitis, Silhouette sign Pneumothorax in left lower lobe and right lobe... Doctor if the patient is responding to the treatment as you have mentioned And Is getting well... Please continue... I appreciate your efforts Doctor.!

Thank you doctor
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Yes walk should be start on the bed

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