Cheyne-Stokes Breathing

Recently one of the consultant doctors mentioned Cheyne Stokes breathing. Breathing pattern characterised by: - periods of shallow, deep breathing  and apnoea. e.g. Apneoa followed by respiration of increasing depth and frequency. - symptomatic of congestive heart failure it is a negative symptom increased liklihood of death and difficulty sleeping at night.

Cervical Auscultation

Purpose

• Evaluating the pharyngeal swallow non invasively.
• A stethoscope is used to listen to the breathing/ swallow sounds heard at the laryngopharynx level.
• Can be done on all patients including COPD/ Tracheostomy patients.

Procedure (Stroud, 1999)

1. Tap the Stethoscope to test. Use the concave bell to hear breathing sounds and the flat diaphragm to hear swallow sounds. 
2. Place on the lateral junction between the cricoid cartilage and the trachea. Listen for normal breathing sounds to get a baseline (hollow/tubular sounding) and listen to a dry saliva swallow to get a swallow baseline.
3. Give the patient the trial fluid/solid. Listen to the swallow-breath pattern. Inhalation, Exhalation, Apnea, 2 swallow clicks (VF closure), Expiratory burst. Listen to both sides to check for asymmetrical pooling. A disordered swallow may sound less clear/ bubbly if aspiration occurred. 

Normal Swallow (Zenner et al 1995)

• Swallow occurs promptly after oral transit.
• Apneic period occurs during the swallow.
• Exhalation at the end.

Disordered Swallow

Listen for:

• Premature spillage of the bolus before the pharyngeal swallow is triggered.
• 2 clicks of VF closing - are they absent?
• Exhalation - absent?
• A clearing swallow may be heard,
• Pooling/penetration - e.g. gurgling/ wet breath sounds.

Impaired pharyngeal Swallow

• Tracheal Aspiration = suspected when flushing fluid sound is heard prior to the pharyngeal swallow, or when wet breath sounds/stridor/coughing/throat clearing/voice distortion is heard.
• Dysphagia - different respiratory pattern, more variable, swallow apnea is less consistent, inspiration at the end of the swallow.

 

Family Meeting

Here are some recommendations for myself after feeding back SLT information during a family meeting.

**1**

Keep up to date ICF/ mini ICF forms with information about patients and infomration about their goals and areas targeted by their goals. This will allow me to explain better the patients goals and the priorities for them.

**2**

Greet patients family members and explain my role to them before the family meeting, so as to be less imposing.

**3**

Read the patients MDM notes before the meeting in order to be up to date with their progress/ status.

First Week

I've just finished my first week as a fully qualified SLT!!! After a few days of induction i was onto the stroke unit to see my first patient and get familiar with the way the unit is run. The main difference from my student placements is that you need to think much quicker. I've needed to really organise my thoughts, e.g. what i'm looking for in a patient and why. 

Here are my personal recommendations after reflecting on my performance feeding back to the team about an initial communication assessment:

1. I need to give concrete examples of the language/communication used by the client and examples of what context they were used in e.g. when asked to describe a picture ...... was unable to ..... and was able to convey some meaning through gesture.

2. I need to become fluent at giving jargon free descriptions of my medical diagnoses e.g. Expressive and receptive aphasia.

3. I need to support the patient during the family meeting to a) Understand what we are talking about and b) Contribute to decisions about their care.