A respiratory support system used to remove mucus and clear airway by oscillating pressure on the chest.

Performance comparison of two oscillating positive expiratory pressure devices: Acapella versus Flutter. (1/46)

BACKGROUND: Oscillatory positive expiratory pressure (PEP) with the Flutter device facilitates secretion removal. In the Flutter a steel ball vibrates inside a cone, causing air flow vibration. A new device, the Acapella, uses a counterweighted plug and magnet to create air flow oscillation. The Acapella comes in 2 models: one for patients with expiratory flow > or = 15 L/min and one for < or = 15 L/min. We hypothesized that the Acapella and Flutter would produce similar mean PEP, oscillatory pressure amplitude, and frequency over a clinically relevant range of flows. METHODS: We measured oscillatory amplitude, PEP, and frequency. Values for frequency, peak, trough, and mean pressure were recorded automatically every 3 seconds at flows of 5, 10, 15, 20, 25, and 30 L/min. The pressure waveform for 1 second was also graphically displayed and recorded. The devices were adjusted to give low, medium, and high mean expiratory pressure (Flutter angle at 0, 20, and 40 degrees; Acapella by dial setting). Data were analyzed by 2-way repeated measures analysis of variance, and differences were considered significant when p was < 0.05. RESULTS: There were statistically significant differences between the devices for mean pressure, pressure amplitude, and frequency, for all experimental conditions. However, the differences were relatively small and may not be clinically important. Both devices produced similar pressure waveforms at the medium flows. At 5 L/min the Acapella produced a more stable waveform, with a lower frequency, higher amplitude, and a slightly wider range of PEP than the Flutter. CONCLUSIONS: Acapella and Flutter have similar performance characteristics. Acapella's performance is not gravity-dependent (ie, dependent on device orientation) and may be easier to use for some patients, particularly at low expiratory flows.  (+info)

Pulmonary hyperinflation and respiratory distress following solvent aspiration in a patient with asthma: expectoration of bronchial casts and clinical improvement with high-frequency chest wall oscillation. (2/46)

An 18-year-old student with a history of asthma accidentally inhaled organic solvent during a class, with immediate cough and dyspnea that worsened over several hours. He presented in severe respiratory distress, with hypoxemia and marked pulmonary hyperinflation. Administration of inhaled bronchodilator was ineffective because of agitation, and the patient could not be positioned for chest physiotherapy to treat presumed widespread mucus plugging. High-frequency chest wall oscillation (HFCWO) in the sitting position initially caused increased distress but was subsequently tolerated when noninvasive positive-pressure ventilation (NPPV) via nasal mask was initiated. Almost immediately, the patient began expectorating bronchial mucus casts, with concomitant clinical improvement. Endotracheal intubation was avoided, and with aggressive pharmacologic treatment for acute severe asthma and continuation of intermittent HFCWO-NPPV, the patient made a full recovery over the next several days. This case suggests that the combination of HFCWO and NPPV may be helpful in the presence of mucus plugging as a complication of acute inhalation injury or acute severe asthma.  (+info)

Cariporide enables hemodynamically more effective chest compression by leftward shift of its flow-depth relationship. (3/46)

When given during closed-chest resuscitation, cariporide (4-isopropyl-methylsulfonylbenzoyl-guanidine methanesulfonate; a selective inhibitor of the Na(+)/H(+) exchanger isoform-1) enables generation of viable perfusion pressures with less depth of compression. We hypothesized that this effect results from greater blood flows generated for a given depth of compression. Two series of 14 rats each underwent 10 min of untreated ventricular fibrillation followed by 8 min of chest compression before defibrillation was attempted. Compression depth was adjusted to maintain an aortic diastolic pressure (ADP) between 26 and 28 mmHg in the first series and between 36 and 38 mmHg in the second series. Within each series, rats were randomized to receive cariporide (3 mg/kg) or NaCl (0.9%; control) before chest compression was started. Blood flow was measured using 15-mum fluorescent microspheres. Less depth of compression was required to maintain the target ADP when cariporide was present in both series 1 (13.6 +/- 1.2 vs. 16.6 +/- 1.2 mm; P < 0.001) and series 2 (15.3 +/- 1.0 vs. 18.9 +/- 1.5 mm; P < 0.001). Despite less compression depth, the cardiac index in cariporide-treated rats was comparable to control rats in series 1 (11.1 +/- 0.7 vs. 11.3 +/- 1.4 ml.min(-1).kg(-1); P = not significant) but higher in series 2 (15.5 +/- 2.3 vs. 9.9 +/- 1.4 ml.min(-1).kg(-1); P < 0.05). Increases in compression depth (from series 1 to series 2) increased myocardial, cerebral, and adrenal blood flow in cariporide-treated rats. We conclude that cariporide enhances the efficacy of closed-chest resuscitation by leftward shift of the flow-depth relationship.  (+info)

Investigation of non-uniform airflow signal oscillation during high frequency chest compression. (4/46)

BACKGROUND: High frequency chest compression (HFCC) is a useful and popular therapy for clearing bronchial airways of excessive or thicker mucus. Our observation of respiratory airflow of a subject during use of HFCC showed the airflow oscillation by HFCC was strongly influenced by the nonlinearity of the respiratory system. We used a computational model-based approach to analyse the respiratory airflow during use of HFCC. METHODS: The computational model, which is based on previous physiological studies and represented by an electrical circuit analogue, was used for simulation of in vivo protocol that shows the nonlinearity of the respiratory system. Besides, airflow was measured during use of HFCC. We compared the simulation results to either the measured data or the previous research, to understand and explain the observations. RESULTS AND DISCUSSION: We could observe two important phenomena during respiration pertaining to the airflow signal oscillation generated by HFCC. The amplitudes of HFCC airflow signals varied depending on spontaneous airflow signals. We used the simulation results to investigate how the nonlinearity of airway resistance, lung capacitance, and inertance of air characterized the respiratory airflow. The simulation results indicated that lung capacitance or the inertance of air is also not a factor in the non-uniformity of HFCC airflow signals. Although not perfect, our circuit analogue model allows us to effectively simulate the nonlinear characteristics of the respiratory system. CONCLUSION: We found that the amplitudes of HFCC airflow signals behave as a function of spontaneous airflow signals. This is due to the nonlinearity of the respiratory system, particularly variations in airway resistance.  (+info)

Inspiratory oscillatory flow with a portable ventilator: a bench study. (5/46)

INTRODUCTION: We observed an oscillatory flow while ventilating critically ill patients with the Drager Oxylog 3000 transport ventilator during interhospital transfer. The phenomenon occurred in paediatric patients or in adult patients with severe airway obstruction ventilated in the pressure-regulated or pressure-controlled mode. As this had not been described previously, we conducted a bench study to investigate the phenomenon. METHODS: An Oxylog 3000 intensive care unit ventilator and a Drager Medical Evita-4 NeoFlow intensive care unit ventilator were connected to a Drager Medical LS800 lung simulator. Data were registered by a Datex-S5 Monitor with a D-fend flow and pressure sensor, and were analysed with a laptop using S5-Collect software. Clinical conditions were simulated using various ventilatory modes, using various ventilator settings, using different filters and endotracheal tubes, and by changing the resistance and compliance. Data were recorded for 258 combinations of patient factors and respirator settings to detect thresholds for the occurrence of the phenomenon and methods to overcome it. RESULTS: Under conditions with high resistance in pressure-regulated ventilation with the Oxylog 3000, an oscillatory flow during inspiration produced rapid changes of the airway pressure. The phenomenon resulted in a jerky inspiration with high peak airway pressures, higher than those set on the ventilator. Reducing the inspiratory flow velocity was effective to terminate the phenomenon, but resulted in reduced tidal volumes. CONCLUSION: Oscillatory flow with potentially harmful effects may occur during ventilation with the Drager Oxylog 3000, especially in conditions with high resistance such as small airways in children (endotracheal tube internal diameter <6 mm) or severe obstructive lung diseases or airway diseases in adult patients.  (+info)

Physiologic evidence for high-frequency chest wall oscillation and positive expiratory pressure breathing in hospitalized subjects with cystic fibrosis. (6/46)

BACKGROUND AND PURPOSE: This investigation identified ventilation distribution, gas mixing, lung function, and arterial blood oxyhemoglobin saturation (SpO2) physiologic responses to 2 independent airway clearance treatments, high-frequency chest wall oscillation (HFCWO) and low positive expiratory pressure (PEP) breathing, for subjects who had cystic fibrosis (CF) and who were hospitalized during acute and subacute phases of a pulmonary exacerbation. SUBJECTS: Fifteen subjects with moderate to severe CF were included in this study. METHODS: Subjects performed single-breath inert gas tests and spirometry before and immediately after HFCWO and PEP breathing at admission and discharge. Arterial blood oxyhemoglobin saturation was monitored throughout each treatment. RESULTS: At admission and discharge, PEP breathing increased SpO2 during treatment, whereas HFCWO decreased SpO2 during treatment. Ventilation distribution, gas mixing, and lung function improved after HFCWO or PEP breathing. DISCUSSION AND CONCLUSION: High-frequency chest wall oscillation and PEP breathing are similarly efficacious in improving ventilation distribution, gas mixing, and pulmonary function in hospitalized people with CF. Because SpO2 decreases during HFCWO, people who have moderate to severe CF and who use HFCWO should have SpO2 monitored during an acute exacerbation.  (+info)

Physiological effects of vibration in subjects with cystic fibrosis. (7/46)

The physiological mechanisms by which vibration and other physiotherapy interventions may clear secretions in subjects with cystic fibrosis are unknown. The main aim of this study was to compare the expiratory flow rates and frequencies of airflow oscillation of vibration to those of Acapella(R), Flutter(R), positive expiratory pressure and percussion. Respiratory flow rates were measured during interventions, the order of which was randomised. The oscillation of the airflow of the interventions was determined by frequency spectral analysis. In 18 young adult subjects with cystic fibrosis, the mean peak expiratory flow rate of vibration was greater than Flutter(R), percussion, Acapella(R) and positive expiratory pressure. The mean+/-sd of the oscillation of the airflow of vibration (8.4+/-0.4 Hz) was lower than Acapella(R) (13.5+/-1.7 Hz) and Flutter(R) (11.3+/-1.5 Hz) but similar to percussion (7.3+/-0.3 Hz). Theoretically, the higher peak expiratory flow rate of vibration compared to the other physiotherapy interventions may promote secretion clearance. In addition, the frequency of oscillation of vibration was within the range demonstrated to increase mucus transport. This study has provided some evidence for the physiological rationale for the use of vibration to aid secretion clearance.  (+info)

Immediate changes in blood-gas tensions during chest physiotherapy with positive expiratory pressure and oscillating positive expiratory pressure in patients with cystic fibrosis. (8/46)

OBJECTIVE: To assess and compare immediate effects of chest physiotherapy with positive expiratory pressure (PEP) versus oscillating PEP on transcutaneously measured blood-gas tensions in patients with cystic fibrosis. METHODS: Fifteen patients (mean age 12.5 y, range 6.9-21.5 y) participated. The treatments were randomized and performed on 2 separate occasions, 8 weeks apart. Spirometry was conducted before and after each treatment. We transcutaneously measured oxygen tension (P(tO2). RESULTS: There were no changes in spirometry values. During PEP, different trends in blood-gas tension were seen, and there were no consistent changes. During oscillating PEP, P(tO2) increased and P(tCO2) decreased. During oscillating PEP, P(tCO2) was lower and the intra-individual change in P(tCO2) was more pronounced than during PEP. The results obtained immediately after oscillating PEP showed a higher P(tO2) and a lower P(tCO2) than with PEP. CONCLUSION: PEP and oscillating PEP can both cause transitory effects on blood gases in patients with cystic fibrosis. However, oscillating PEP alters blood-gas tensions more than does PEP, and hyperventilation during oscillating PEP may reduce treatment time.  (+info)

Chest wall oscillation is a technique used in physical therapy to help clear secretions from the airways in individuals with respiratory conditions such as cystic fibrosis, bronchiectasis, or chronic obstructive pulmonary disease (COPD). It involves the use of an inflatable vest or wrap that is connected to a machine that delivers rapid, small bursts of air. These bursts cause the chest wall to oscillate or vibrate, which helps to loosen and mobilize secretions in the airways.

The therapy can be administered in different ways, including high-frequency chest wall oscillation (HFCWO), intrapulmonary percussive ventilation (IPV), and mechanical insufflation-exsufflation (MI-E). The goal of chest wall oscillation is to improve lung function, reduce the risk of respiratory infections, and enhance overall quality of life.

It's important to note that chest wall oscillation should only be performed under the guidance and supervision of a trained healthcare professional, as improper use can lead to discomfort or injury.

  • It uses a compressor to inflate and deflate the vest rhythmically at timed intervals and thus imposes high frequency chest wall oscillations (HFCWO) that are transferred to the lungs. (wikipedia.org)
  • The company manufacturers the first completely self-contained, battery operated, portable HFCWO High Frequency Chest Wall Oscillation device that provides critical therapy for people with Cystic Fibrosis, Bronchiectasis and other respiratory diseases. (areadevelopment.com)
  • The SmartVest SV2100 is a high-frequency chest wall oscillation (HFCWO) device. (somatechnology.com)
  • Today, hospitalists and directors of respiratory care increasingly value high frequency chest wall oscillation (HFCWO), also known as high frequency chest compression (HFCC), as their therapy of choice for treating compromised airway clearance in acute care settings. (somatechnology.com)
  • Ever since High Frequency Chest Wall Oscillation (HFCWO) devices were developed to help patients with cystic fibrosis breathe easier, clinical researchers required appropriate parameters to assess the efficacy of HFCWO-based therapies. (cysticfibrosisnewstoday.com)
  • The data algorithms from these brief and continual clinical calls measure patient engagement, identify gaps in care for physician follow-up, and detect increased clinical impairments that lead to advanced therapies such as NIV and high frequency chest wall oscillation (HFCWO). (vgm.com)
  • Recently, this has led to some use of high-frequency chest wall oscillation (HFCWO), intrapulmonary percussive ventilation (IPV), cough support, respiratory muscle training, and other techniques. (fizyoplatforum.com)
  • This technology is also called high-frequency chest wall oscillation (HFCWO). (theinsightpartners.com)
  • based on types, the market is segmented as Positive Expiratory Pressure (PEP),Flutter Mucus Clearance Device, High Frequency Chest Wall Oscillation (HFCWO),Intrapulmonary Percussive Ventilation (IPV),Others. (theinsightpartners.com)
  • Sometimes, people that have been sick for some time may benefit from HFCWO (High Frequency Chest Wall Oscillation) treatments to help them clear their airways. (medafore.com)
  • The Hill-Rom Vest 105 Airway Clearance System is the most commonly used High Frequency Chest Wall Oscillation (HFCWO) system in the world. (medafore.com)
  • 2018. Incidence of Bronchiectasis-Related Exacerbation Rates After High Frequency Chest Wall Oscillation (HFCWO) Treatment - A Longitudinal Outcome-Based Study. (livingwithbe.com)
  • The Vest® Airway Clearance System, Model 105 represents technology from the innovators of High Frequency Chest Wall Oscillation or HFCWO. (bemesonline.com)
  • Once chest physiotherapy (CPT) was the standard of care for external chest manipulation. (somatechnology.com)
  • Traditional chest physiotherapy (CCPT) is comparable in effectiveness to other airway cleansing techniques and remains a combination of techniques that some people find useful and prefer. (fizyoplatforum.com)
  • The long-accepted treatment for impaired mucociliary clearance is chest physiotherapy (CPT), introduced into standard CF care in the 1960s. (respiratory-therapy.com)
  • It is known that chest percussion is the main recommended technique of physiotherapy in our country. (ecorn-cf.eu)
  • This section discusses the devices used to deliver supplemental oxygen and air flow, the humidification of inhaled gases, methods to mitigate airway edema, techniques by which chest physiotherapy is performed and noninvasive ventilation. (pedsurglibrary.com)
  • Oscillatory positive expiratory pressure (OPEP) is an airway clearance therapy that delivers positive pressure and air-flow oscillations during exhalation. (rcjournal.com)
  • 1 , 2 OPEP devices produce positive expiratory pressure with the addition of oscillations as the patient inspires a slightly larger than normal tidal volume and actively exhales through the device. (rcjournal.com)
  • The air pulse generator on the SmartVest creates air pulses that are transmitted to the chest via the connection hose and vest. (somatechnology.com)
  • Finally, patients that suffer from other conditions that cause muscle weakness may also find CPT (Chest Percussion Therapy) using the Hill-Rom Vest helpful. (medafore.com)
  • The Hill-Rom Vest uses an air pulse generator to create high frequency oscillations. (medafore.com)
  • The oscillations are transmitted from the air pulse generator via a set of two hoses to a vest garment. (medafore.com)
  • Chest wall oscillation is when devices are used in airway clearance therapy to clear excess mucus from lung airways (bronchi and bronchioles). (wikipedia.org)
  • These oscillations thin thixotropic airway mucus, facilitating its removal by coughing. (wikipedia.org)
  • The rapid chest movements can dislodge and thin the mucus, moving it towards the central airways. (theinsightpartners.com)
  • These oscillations liquify excess mucus in the lungs. (medafore.com)
  • The Airway Clearance System is a unique therapy system designed to help mobilize pulmonary secretions through high frequency chest wall oscillation. (theinsightpartners.com)
  • It allowed patients to receive their CPT (chest percussion therapy) in the comfort of their own home. (medafore.com)
  • This therapy also works by a wearable garment creating gentle oscillations, rapidly compressing and releasing the chest wall to oscillate airflow within the airways. (livingwithbe.com)
  • International Biophysics is also introducing the new AffloVest Pro, a special infection control enhanced hospital version, which is disposable and gives healthcare professionals greater oscillation control to target specific parts of the lungs. (areadevelopment.com)
  • The chest trauma that results from a motor vehicle accident may result in injury to the sternum, the ribs, and the heart, aorta, and lungs. (medscape.com)
  • Most of the techniques mentioned may be associated with postural drainage or percussion and chest compression. (ecorn-cf.eu)
  • However, there is also a study (from the Brompton group), which investigated 32 adult patients over 4 days comparing usual airway clearance techniques to high frequency chest wall oscillation. (ecorn-cf.eu)
  • Purpose: This study aimed to evaluate the efficacy of high-frequency chest wall oscillation for sputum expectoration and hospital length of stay in patients with acute exacerbations of chronic obstructive pulmonary disease. (tmu.edu.tw)
  • Chest compression apparatus, Warren J. Warwick et al. (wikipedia.org)
  • Improved Retention of Chest Compression Psychomotor Skills With Brief "Rolling Refresher" Training. (jefferson.edu)
  • Quantitative analysis of chest compression interruptions during in-hospital resuscitation of older children and adolescents. (jefferson.edu)
  • Neonatal CPR: room at the top--a mathematical study of optimal chest compression frequency versus body size. (jefferson.edu)
  • Chest compression quality over time in pediatric resuscitations. (jefferson.edu)
  • These devices include mechanical percussors, external oscillatory devices (high-frequency chest-wall compression and sonic oscillation), internal oscillatory devices (handheld airway oscillators and intrapulmonary percussive ventilation), and positive expiratory pressure (PEP) mask therapy. (respiratory-therapy.com)
  • The literature reports that air-flow oscillations help to mobilize secretions by reducing the viscosity and creating small bursts of air that move secretions cephalad. (rcjournal.com)
  • It is the original High Frequency Chest Wall Oscillation Device by Advanced Respiratory, Inc (ARI), formerly American Biosystems, Inc., in Saint Paul, Minnesota, United States of America. (wikipedia.org)
  • Depending on the device, different mechanisms are used to create air-flow oscillations. (rcjournal.com)
  • Each type of device uses unique mechanisms to produce air-flow oscillations ( Fig. 1 ). (rcjournal.com)
  • 7) The techniques applied may include percussion, chest shaking, and vibrations. (fizyoplatforum.com)
  • The SmartVest SV2100 airway clearance system is designed to deliver high-frequency chest oscillation to promote airway clearance and improve bronchial drainage. (somatechnology.com)
  • An inconvenient application in practice is the high price of the equipment for high frequency chest compressions. (ecorn-cf.eu)
  • And mechanical, High-Frequency Chest Wall Oscillation Systems can help break the cycle. (medafore.com)
  • Impact of High Frequency Chest Wall Oscillation on Clinical Outcomes and Healthcare Resource Utilization in Adult Patients with Non-Cystic Fibrosis Bronchiectasis in the United States: A Pre-Post Cohort Analysis. (livingwithbe.com)
  • Effectiveness of treatment with high-frequency chest wall oscillation in patients in patients with bronchiectasis. (livingwithbe.com)
  • The chest wall is rhythmically struck, transmitting vibrations to the underlying lung tissue. (respiratory-therapy.com)
  • The generator rapidly inflates and deflates, by compressing and releasing the chest wall. (theinsightpartners.com)
  • This rapidly compresses and releases the chest wall, oscillating airflow within the airways. (livingwithbe.com)
  • The chest radiograph reveals a left lower lobe opacity with pleural effusion. (medscape.com)
  • In combination with neuromuscular blockers, anesthetic agents cause diaphragm and chest wall relaxation, which results in a marked reduction in the functional reserve capacity and, thereby, thoracic volume. (medscape.com)
  • Radiographs can depict bony trauma, and rib fractures are among the most commonly identified injuries to the chest. (medscape.com)
  • A significantly greater number of patients in the bronchoscopy group achieved complete or near-complete resolution on chest X-ray, compared with the conservative group (p=0.007). (bmj.com)
  • Radiography of the chest should be a routine part of autopsies of patients who die of injuries that result from traffic accidents. (medscape.com)
  • A period of weeks to months of a wet cough may follow what appeared to be an ordinary chest cold, with gradual resolution. (respiratory-therapy.com)
  • Image depicting multiple fractures of the left upper chest wall. (medscape.com)
  • A Novel Nonlinear Mathematical Model of Thoracic Wall Mechanics During Cardiopulmonary Resuscitation Based on a Porcine Model of Cardiac Arrest. (jefferson.edu)
  • It is the original High Frequency Chest Wall Oscillation Device by Advanced Respiratory, Inc (ARI), formerly American Biosystems, Inc., in Saint Paul, Minnesota, United States of America. (wikipedia.org)
  • The use of the Flutter(®)VRP1 for four weeks is capable of altering the respiratory secretion transport properties, and this alteration is related to the high frequency oscillation component. (nih.gov)
  • In clinical practice, chest wall and formal respiratory function tests are difficult to perform owing to the small size and cooperation. (nih.gov)
  • Depending on the circumstances, chest physical therapy may be performed by anyone ranging from a respiratory care therapist to a trained member of the patient's family. (encyclopedia.com)
  • The free-text field related to 'Respiratory high frequency chest wall oscillation system use frequency' specifying other text. (nih.gov)
  • Changes in chest wall geometry and diaphragm position are the most recognized and studied mechanisms contributing to respiratory muscle dysfunction. (afflovest.com)
  • and AffloVest, a portable high frequency chest wall oscillation vest for the treatment of retained pulmonary secretions, such as bronchiectasis, cystic fibrosis, and various neuromuscular disorders. (etfdailynews.com)
  • Her SmartVest is a high-frequency chest wall oscillation inflatable vest that is attached to a machine. (marleesmagic.com)
  • Requires sufficient airflow to induce airway oscillations. (ddxof.com)
  • Struggling for air during exercise or bouts of breathlessness is a common cause of chest pain and tightness for COPD patients. (lptmedical.com)
  • Manual percussions and vibrations are applied externally to the chest wall to exert a vibrating, shaking force to loosen sputum within the airways. (medscape.com)
  • Once the arm reaches 90°, the clinician slowly externally rotates the arm while continuing traction, oscillations, and abduction. (medscape.com)
  • The clinician then applies continuous, vertical oscillations that last 2-3 seconds while continuing slow arm abduction. (medscape.com)
  • The elastic fibers in the walls of alveoli and alveolar ducts, which form a continuous network with elastic fibers in the small and larger airways, are an important structural determinant of these interactions [ 10 , 11 ]. (biomedcentral.com)
  • COPD can spawn several types of temporary and chronic pain, including pain in your chest, spine, muscles, joints, and even your bones. (lptmedical.com)
  • Radiographs can depict bony trauma, and rib fractures are among the most commonly identified injuries to the chest. (medscape.com)
  • Chest CT is more important in general assessment of trauma for other injuries. (medscape.com)
  • The airway lumen enlarges and walls thin as connective tissue components are reduced. (bmj.com)
  • The dead sat on the wall staring down at their captor who would join them before cure or treatment. (wikidot.com)
  • The animals that blanketed the old Earth with their remains will be remembered," Amon said, "The diggers remembered in myth," Her heart slowed its oscillations, calming her tumor-nestled chest. (wikidot.com)
  • To possess no the urine during the heart walls collapse. (brainofshawn.com)
  • For example, percussions and vibrations involve 'hands-on' manual clapping or vibrating directly on the chest wall, usually applied via the assistance of another individual, to mechanically loosen sputum within the airways. (medscape.com)
  • Once reduced, the physician internally rotates the shoulder and gently lays the forearm on the chest wall. (medscape.com)
  • Chest CT is considered the gold standard of detecting rib fractures, but the fractures may not be clinically significant. (medscape.com)
  • All of your life you chipped at a wall, poor woman, never stopping. (wikidot.com)

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