pulmonary Flashcards
postoperative pulm complications
- atelectasis, 2. infection
- bronchospasm
- exacerbation of chronic lung disease
- prolonged mechanical ventilation
RF for postoperative pulm complications
- older than 50
- emergency surgery or duration more than 3 h
- HF
- COPD
- Poor general health
preoperative strategies to reduce the risk of postoperative pulm complications
- smoking cessation at least 8 wks prior
- symptom control of COPD
- Treatment of any resp infections prior
- patient education for lung expansion maneuvers
postoperative strategies to prevent posoperative pulm complications
- incentive spirometry (the best)
- deep breathing exercise
- epidural analgesia instead of paraenteral opioids
- Continuous positive airway pressure
flail chest - pathophysiology
3 or more continguous ribs fractured in 2 or more locations
flail chest findings
paradoxiccal chest wall motion with respiration
chest pain, tachypnea, rapid shallow breaths
CXR: rib fractures +/- contusion/hemothorax
Management of flail chest
pain control, O2
positive pressure ventilation if resp failure
clinical indicators of thermal and smoke inhalation injury include
- Burns on the face
- singeing of the eyebros
- oropharyngeal infl
- blistering or carbon deposits
- STRIDOR
- HbCO levels more than 10%
- History of confinement in a burning building
evaluation of bleeding
- rule out other causes
A. mild to moderate –> chest x-ray, CBC, coagulation studies, renal function, urinalysis, rheumatologic workup –> treat cause
–> CT scan +/- bronchoscopy (depends on image results
B. Massive (more than 600/24h or 100ml/h) –> secure ABC: If bleeding stops –> (x-ray, CBC etc), if continues –> treat cause
positive pressure mechanical ventilation in a patient with hemor shock
increased intrathoracic pressure –> further decreased Venous return –> cardiac arrest
spontaneous pneumothorax - management
2 cm or smaller: observation + O2
large + stable: needle aspiration or chest tube
EF in hypovolemic shock
increased
Diaphragmatic rupture?
more common in the lest
- resp distress and can have deviation of the mediastinal contents to the opposite side, elevation of the hemidiaphragm on the chest x-ray might be the only abnormal finding
- also nasogastric tube in the pulm cabity is diagnostic
important step in the management of ribs fracture
adequate analgesia –> prevent hypoventilation (and so atelectasis or pneumonia)
septic shock - HCO3-?
only in ph under 7.2
pulmonary contusion - clinical features
present less than 24 h after blunt thoracic trauma
- tachypnea, tachycardia
- HYPOXIA
pulm contusion - diagnosis
- rales or decreased breath sounds
- CT scan (most sensitive) on CXR with patchy, alveolar, infiltrate not restricted by anatomycal borders
pulm contusion - management
pain control
pulm hygiene (eg. nebulizer treatment, chest PT)
O2 + ventilatory support
avoid fluids / use diuretics
chest xray suggestive for diaphragmatic rupture - next step
chest and abdominal CT
massive hemoptysis - definition
more than 600 ml / d
or more than 100ml/h
bleeding lung in the dependent position
lateral position
tracheobronchial tear - sign
Hamman sign –> audible crepitus on cardiac ausculation
sternum tenderness
spontaneous pneumothorax - types
1ry: no preceding event or lung disease, thin young men
2ry: underlying Lung disease
signs and symptoms of spontaneous vs tension pneumothorax
spontan: chest pain, dyspnea, diminished breath sounds and chest movement, hyperresonance
tension: SAME + hemodynamic instability, tracheal deviation away
imaging on spontaneous vs tension
spontaneous: absent lung marking, visceral pleural line
tension: SAME + mediastinal shift + ipsilateral hemidiaphragm flatterning
another cause of fat embolism
pancreatitis
persistent bleeding after bronchoscopy
embolization
massive hemothorax is defined as
more than 1.5 L
postoperative atelectasis - days
2 + 3
postoperative fever - MNEMONIC
Wind (day 1-2) (lungs): Atelectasis, postoperative pneumonia
Water (day 3-5): UTI
Walk (day 5-7): DVT / PE + IV ACCESS LINES
Wound (day 7): surgical site infection
Weird (8-15): drug fever or deep abscess
Wonder (drugs/products): drug fever, blood products, IV lines
