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Surgery > pulmonary > Flashcards

pulmonary Flashcards

1
Q

postoperative pulm complications

A
  1. atelectasis, 2. infection
  2. bronchospasm
  3. exacerbation of chronic lung disease
  4. prolonged mechanical ventilation
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2
Q

RF for postoperative pulm complications

A
  1. older than 50
  2. emergency surgery or duration more than 3 h
  3. HF
  4. COPD
  5. Poor general health
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3
Q

preoperative strategies to reduce the risk of postoperative pulm complications

A
  1. smoking cessation at least 8 wks prior
  2. symptom control of COPD
  3. Treatment of any resp infections prior
  4. patient education for lung expansion maneuvers
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4
Q

postoperative strategies to prevent posoperative pulm complications

A
  1. incentive spirometry (the best)
  2. deep breathing exercise
  3. epidural analgesia instead of paraenteral opioids
  4. Continuous positive airway pressure
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5
Q

flail chest - pathophysiology

A

3 or more continguous ribs fractured in 2 or more locations

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6
Q

flail chest findings

A

paradoxiccal chest wall motion with respiration
chest pain, tachypnea, rapid shallow breaths
CXR: rib fractures +/- contusion/hemothorax

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7
Q

Management of flail chest

A

pain control, O2

positive pressure ventilation if resp failure

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8
Q

clinical indicators of thermal and smoke inhalation injury include

A
  1. Burns on the face
  2. singeing of the eyebros
  3. oropharyngeal infl
  4. blistering or carbon deposits
  5. STRIDOR
  6. HbCO levels more than 10%
  7. History of confinement in a burning building
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9
Q

evaluation of bleeding

A
  • 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
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10
Q

positive pressure mechanical ventilation in a patient with hemor shock

A

increased intrathoracic pressure –> further decreased Venous return –> cardiac arrest

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11
Q

spontaneous pneumothorax - management

A

2 cm or smaller: observation + O2

large + stable: needle aspiration or chest tube

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12
Q

EF in hypovolemic shock

A

increased

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13
Q

Diaphragmatic rupture?

A

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
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14
Q

important step in the management of ribs fracture

A

adequate analgesia –> prevent hypoventilation (and so atelectasis or pneumonia)

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15
Q

septic shock - HCO3-?

A

only in ph under 7.2

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16
Q

pulmonary contusion - clinical features

A

present less than 24 h after blunt thoracic trauma

  • tachypnea, tachycardia
  • HYPOXIA
17
Q

pulm contusion - diagnosis

A
  • rales or decreased breath sounds

- CT scan (most sensitive) on CXR with patchy, alveolar, infiltrate not restricted by anatomycal borders

18
Q

pulm contusion - management

A

pain control
pulm hygiene (eg. nebulizer treatment, chest PT)
O2 + ventilatory support
avoid fluids / use diuretics

19
Q

chest xray suggestive for diaphragmatic rupture - next step

A

chest and abdominal CT

20
Q

massive hemoptysis - definition

A

more than 600 ml / d

or more than 100ml/h

21
Q

bleeding lung in the dependent position

A

lateral position

22
Q

tracheobronchial tear - sign

A

Hamman sign –> audible crepitus on cardiac ausculation

sternum tenderness

23
Q

spontaneous pneumothorax - types

A

1ry: no preceding event or lung disease, thin young men
2ry: underlying Lung disease

24
Q

signs and symptoms of spontaneous vs tension pneumothorax

A

spontan: chest pain, dyspnea, diminished breath sounds and chest movement, hyperresonance
tension: SAME + hemodynamic instability, tracheal deviation away

25
Q

imaging on spontaneous vs tension

A

spontaneous: absent lung marking, visceral pleural line
tension: SAME + mediastinal shift + ipsilateral hemidiaphragm flatterning

26
Q

another cause of fat embolism

A

pancreatitis

27
Q

persistent bleeding after bronchoscopy

A

embolization

28
Q

massive hemothorax is defined as

A

more than 1.5 L

29
Q

postoperative atelectasis - days

A

2 + 3

30
Q

postoperative fever - MNEMONIC

A

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

Surgery (10 decks)

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