Cardiothoracics Flashcards
How may someone present post trauma with a haemothorax?
dysopnea, tachycardia, chest pain, they can also be hypoxic and hypotensive.
What examination findings would you expect with a haemothorax?
dullness to percussion
reduced breath sounds
reduced chest expansion
tracheal deviation to the non-affected side.
What is a flail chest ?
three or more broken ribs in 2 or more locations
What clinical sign would make you suspicious of a flail chest?
paradoxical breathing movements
What imaging modality would you choose for haemothorax and what would it show?
a meniscuc level and mediastinal shift, blunting of the costophrenic angle.
What is the treatment of haemothorax in the majority of cases?
Chest drain with 28-40F tubes
for patients who have continued bleeding despite chest drain insertion what treatment is recommended?
surgical exploration , thoracotomy or VATS
What is the difference between a pneumothorax and a tension pneumothorax?
both have air in the pleural cavity but tension is when there is haemodynamic compromise from progressive accumulation of air in the cavity, increased positive pressure, a one way valve letting air in.
What are the consequences of leaving a tension PTX untreated?
can lead to mediastinal shift, reduced venous return and cardiac arrest
How will someone present with a PTX?
SOB, pleuritic chest pain,
What are the clinical examination findings of a patient with a pneumothorax?
hyperresonance to percussion, no breath sounds, non expantile on the affected side.
How will someone present with a tension pnaumothorax?
hypoxic, tachycardic, hypotensive, distemded neck veins and tracheal deviation away from the affected side.
What is the management for a small < 2 cm primary spontaneous pneumothorax?
oxygen, observations, DC after 2 4hours
for symptomatic or large pneumothoraces what management is recommended
needle aspiration at the 2nd or 3rd 3rd ICS mid clavicular line . If no improvement then a chest drain needs to be inserted
What is the gold stadnard for investigation for CAD?
coronary angiogram
What are indications for CABG over PCI?
Triple vessel disease, complicated double vessel disease, Left main stenosis > 50%, or LAD > 70%. If diabetic, of MV regurg ventricular dyfunction.
What are candidates for harvest sites for CABG?
GSV or radial artery and the left internal mammary artery
The main 3 risks of CABG are?
MI, stroke and death
What two controls are inserted temporarily post CABG?
Chest drain and pacing wires
What is the path of the superior epigastric artery?
subclavian, internal mammary, then pass through the diaphragm to become the superior epigastric.
at what thoracic vertebral level does the trachea bifurcate?
T4
What can cause tracheal stenosis?
prolonged intubation pressure injury, prior tracheostomy or if tracheostomy is too high.
When would surgery for pectus excavatum be considered?
If there is cardiovascular or respiratory compromise
what 2 categories for lung cancer are there?
small cell and non small cell
Apart from smoking what are other risk factors for lung cancer?
asbestos, radon gas, radiation , air pollution.
Tumours in the apex of the lung are called?
pancoast tumours
What three nerve bundles are affected by a pancoast tumour?
brachial plexus (upper limb weakness/ parasthesia)
recurrent laryngeal nerve, hoarse voice
sympathetic chain (ptosis, myosis, anhydrosis)
phrenic nerve (hemidiaphragm elevation )
IVC: facial plethora
What paraneoplastic conditions can come from lung cancers?
SCC; can make Parathyroid hormone relates peptide which causes hypercalcaemia.
adenocarcinima: hypertrophic osteoarthropathy , clubbing, joint pain.
Small cell: ADH lead to hyponatraemia or ACTH leadign to chusings
Which tumours are suitable for surgical resection?
non-small cell
What surgical treatment options are available for resecting lunc cacner?
pneumonecromy, lobectomy, sleeve resection, wedge resection.
What should the FEV 1 be prior to a pneumonectomy?
2L and 1 L for lobectomy
