Cardiopulmonary Physical Therapy: a Guide to Practice, ed 4.

Cardiopulmonary Physical Therapy: A Guide to Practice, ed 4

Irwin S, Tecklin JS, eds. St Louis, MO 63146, Mosby Inc, 2004, hardcover, 491 pp, illus, ISBN: 0-323-01840-8, $74.95.

This text was primarily written for use in professional physical therapist curricula and for the clinician who may be inexperienced in cardiopulmonary care. The editors' intent is to provide the basic science and medical science information, related to the cardiovascular and pulmonary areas, that is necessary to perform physical therapist examinations, evaluations, and interventions. The fourth edition of this text differs substantially from previous editions because the editors have focused the section titled "Physical Therapy" on all 8 cardiovascular/pulmonary Preferred Physical Therapist Practice Patterns[SM] in the second edition of the Guide to Physical Therapist Practice (Guide).

The text is divided into 3 major sections: "Basic Sciences," "Medical Sciences," and "Physical Therapy." The "Basic Sciences" section includes 4 chapters: "Cardiovascular Structure and Function," "Respiratory Physiology: Structure, Function, and Integrative Responses to Intervention With Special Emphasis on the Ventilatory Pump," "Normal and Abnormal Cardiopulmonary Responses to Exercise," and "Cardiopulmonary Changes With Aging." This section contains illustrations and anatomical photographs that help readers determine the spatial orientation of the cardiovascular and pulmonary anatomy. The authors go into detail regarding the cardiac and respiratory anatomy, which would be comprehensive information for physical therapist students and a good review for practicing clinicians. Clinical correlations are presented for certain anatomical structures that are pertinent to physical therapist practice, such as clinical implications of left heart failure and right heart failure. In addition, the book provides case examples related to stroke volume and poses questions to stimulate thought. Detailed explanations of respiratory physiology provide an excellent review for clinicians. At the end of each chapter, the authors provide a summary of the chapter and an expansive list of references. Several references used throughout the text, however, are dated, and more recent references could be used in certain areas as indicated below.

The second section, "Medical Sciences," includes 5 chapters: "Cardiac Disease and Pathophysiology," "Common Pulmonary Diseases," "Common Cardiac and Pulmonary Clinical Measures," "Drug Therapy of Common Cardiac Disorders," and "Pulmonary Pharmacology." These chapters provide background information and a review or overview of common cardiac and pulmonary disorders such as coronary artery disease, cystic fibrosis, chronic obstructive pulmonary disorder, and so on. Although there have been some advances in research on cystic fibrosis since 1995, the information on this disease is very similar to that contained in the third edition. This section also describes the basic principles of electrocardiography, which includes the electrophysiology of the heart. There are 19 pages of charts of various electrocardiogram (EKG) strips with a summary of the EKG characteristics, etiology, and treatment. The references for many of the EKG strips are from various texts, including nursing texts, that were published 1978 to 1990. The book describes various pulmonary, tests and measures, including imaging, arterial blood gases, and pulmonary function testing. Clinical scenarios are presented in an understandable and concise manner to illustrate the implications of abnormal test values. Chest radiographs and interpretation of these images are briefly described, with actual images of radiographs and lung studies. Several of the images are from a text published in 1970. The last 2 chapters in this section provide an overview of the medications used for the treatment of common cardiac and pulmonary disorders. The authors acknowledge that these chapters provide a cursory review of pharmacological agents and refer the reader to the extensive bibliography for more detailed information.

The third and final section of the text entitled "Physical Therapy" consists of 8 chapters that address the 8 cardiovascular and pulmonary practice patterns (6A-6H) as outlined in the Guide. Each of these chapters provides detailed information for each element of patient/client management using a case study format. Throughout the case studies, the authors interject references for the reader to review and information relevant to clinical practice. For example, chapter 12, "The Patient with Airway Clearance Dysfunction--Preferred Practice Pattern 6C," contains extensive information regarding breath sounds, auscultation, breathing patterns, and so on. These chapters provide the student and clinician with an organized and detailed approach to the management of patients with various cardiovascular and pulmonary disorders. The format for the case studies in each chapter varies, but this seems to depend on the particular practice pattern and the elements of patient/client management that require emphasis.

Overall, this text is an excellent resource for physical therapist students and physical therapists who may be new to the field of acute care and cardiovascular and pulmonary physical therapy. Because the cardiopulmonary aspects of patient management cross all practice settings, the information presented in the text is relevant to all physical therapists.

Anita Bemis-Dougherty, PT

The Johns Hopkins Hospital 

Baltimore, Md

Ms Bemis-Dougherty is Manager of Physical Therapy and a part-time instructor in physical medicine and rehabilitation at The Johns Hopkins University. She has been involved in acute care clinical practice for 29 years, including acute pulmonary physical therapy.