cardiacthoracic surgery

Question 1

surgical management

Answer 1

anohter growing area in surgery is lung volume reduction surgery - for those whith huge hyper inflation issues.

Question 2

common thoracic surgicsl procedures

Answer 2

lungs - theyre anatomy is in secgments and lobes which makes it esier to remove.

Question 3

lung carcinoma

Answer 3

mostcommon cells - sqaumous and adencarcinoma - can be improved from trearment before surgery. small cell spread very quickly.

Question 4

clinical signs ofthroraccic cancer

Answer 4

cough- becomes slightly different
bone or breast cancer can matistisize to lungs. so can get short breath
getting rid of luymph nodes helps stopping it from spreading and matestising

Question 5

other clinical signs

Answer 5

plura fdvsv-most common symptom

Question 6

investigations

Answer 6

BAL - sputum cytlogy to collect sample of sputum

Question 7

staging

Answer 7

TNM scoring sytem for how the score cancer for all types of cncer. T,N lymph node involvent, MT2 may mean tht the tumour is bigger.
so improtant frifor the MDT and planning treatment; good for research categorising; whi needs surgery? or needs treatent more thn surgery?

Question 8

thoracotomy

Answer 8

on the side and in the middle to allow best access and space

Question 9

thoracic surgicsal

Answer 9

b

Question 10

lobectomy

Answer 10

sometimes were restricted on how far we ca move them cus theyre on suction, so may have to use pedals and be creative with how to mobilise. These chest darins are kept in till theres no air leak or fluid left in the lungs. get patient to cough to see if there is still an air leak.

Question 11

pneumonectomy

Answer 11

take whole lung out then sew up bronchial stump.

Question 12

physiotherapy - pneumon

Answer 12

high mortality - many die. claeful to prtect that stump

Question 13

physiotherapy - pneumon

Answer 13

high mortality - many die. claeful to prtect that stump. these patients are very compicated. dont need pneumo for exam just good to know whst to do

Question 14

lung volume redcution surgery

Answer 14

look at link.

strict criteria for this surgery and nice guidlines. very few procedures perfomred

Question 15

copd patients

Answer 15

cant breath out. always hyper inflated. e.g breathe in thrugh a straw. little quality of life. no exercise tolerance

Question 16

x ray

Answer 16

left side - small diaghram, no space, restricted not enough lungvolume. Right side - healthy and spaced diaphram.

Question 17

pre op physiotherapy

Answer 17

select patients caefully as its such a risky surgery. Cant have any infections. can cuse numerthoracies from the high pressure as a pre op patient.

Question 18

post op physiotherapy

Answer 18

although have big volume now they have a lack of pulmoary reserve.
ABGs not nromal so find whats normal results fro them individually. Want to aim to send them out with a better quality of life.

Question 19

links

Answer 19

shows how thr specialists role as a physio need to do whats best or pateitns

Question 20

chst wall surgery - pecus excavatum

Answer 20

Noramlly these patients have lung dieseas - as lung volumes small. resticed type of lung diease because no not enough space for lung to exand to - same with scolerosis. also after surgery there will be further loss of lung volume. often young and in pain patients, struggle to trsut. have big issues with sats.

Question 21

pecus carinatum / pigeon chest

Answer 21

Plastics get involved in these surgeries - changing shape of cartilage. often young and in pain patients, struggle to trsut. have big issues with sats.

Question 22

thoracoplasty

Answer 22

not done anymore, but shwos the role of evidence and evolving evidence base.

Question 23

pleural surgery

Answer 23

pleuradesis etc

Question 24

pleurodesis

Answer 24

iodise talc, stick the pleura together

Question 25

pleuroectomy

Answer 25

strip off perital pleura

Question 26

thoracic surgery complictions

Answer 26

risk of inflamatary response - in thoracotomies. Some patients comeback atrial fibrillation - comprimising there blood pressure. all these avoided trhough early rehab

Question 27

surgical emphysema

Answer 27

- for patients whove had trauma, numathorax.

Question 28

thoracic trauma - classification

Answer 28

these patients have surgical emphysemas

Question 29

thoracic injuries

Answer 29

if break in more than one place you get a flail chest. fractures causes bruising of the lung tissure too.

Question 30

flail chest

Answer 30

when breahting in can go the wrong way

Question 31

x ray

Answer 31

all the ribs on left side are fractured and broken in more than one place, flail

Question 32

punctured lung | pulmonary contusions.

Answer 32

cant par take in gaseous exchange due to exidate around it when you have a punctured lung as so much brusing. pulmonaey enfusion - bruising of lungs. sometime hve to be intubated and ventilated if cant improve gaseous exchange. this will by them time for them to heal. called a blunt lung injury cus its a secondary problem - high risk of pneumonia. more white in x ray ( right) cuase more fluid.

Question 33

pneumothorax

Answer 33

other types of it too.

Question 34

cxr pneumothorax

Answer 34

starts to push and compress heart, pneumothroax tension which is when cardiac gets involved.

Question 35

haemothorax

Answer 35

cant hear anything. need to drain, so chst drains. on CT scan left side - blsck bit is air in space and white bit at bottom isthe blood. normal lung in midddel but free aire haemopneumothrax in back oaboe as that is free air.

Question 36

haemothorax

Answer 36

cant hear anything. need to drain, so chst drains. on CT scan left side - blsck bit is air in space and white bit at bottom isthe blood. normal lung in midddel but free aire haemopneumothrax in black, above lung, as that is free air.

Question 37

haemothorax

Answer 37

cant hear anything. need to drain, so chst drains. on CT scan left side - blsck bit is air in space and white bit at bottom isthe blood. normal lung in midddel but free air, which is the haemopneumothrax, in black, above lung,

Question 38

what vids for explain how chest drains work. will come in in vivas of what to do when trying to mobilise while keeping safe when patents has chest drains.

Answer 38

vids

Question 39

physiotherpy managemtn in cardiothoracic sugey

Answer 39

on sheet on brown notes

Question 40

post op phydiotherpy

Answer 40

think about the shoulder!!!! when havinga thoracic patient!! dont want a frozen shoulder as patients can cure towards it if in pain etc.

Question 41

pre op

Answer 41

getting nurses and surgeons/doctors on board with your plan

Question 42

secretion clearance

Answer 42

a

Question 43

supported coughing

Answer 43

very important to teach them as patients dont want to cough.

Question 44

scj

Answer 44

dont let patient out of bed too much . do two tratemtsn a bit shorter as this will strength lung volume more but dont want to get them too tired

Question 45

physiotherapy key points

Answer 45

pc

Question 46

mangement

Answer 46

progressing patients | mobility!!!! rehab

Question 47

heart transplant

Answer 47

v

Question 48

lung transplant

Answer 48

v both transplants have all the same physiotherapy managemt as csrdiothoracic surgery management