Resp 3

Question 1

Main lung resection reason

Answer 1

Neoplasm

Question 2

What questions to ask

Answer 2

exercise tolerance? dyspnea? productive cough? cig smoking? Can I see PFT, CXR,

Question 3

Time to quit smoking

Answer 3

> 8 weeks before best so 20% complications vs 50-60% past then. worst is month before.

Question 4

What are some Pul Function tests or measures important?

Answer 4

PFT, FEV1, DLCO, vo2 max

Question 5

Relative contraindications for lung sx

Answer 5

hypercapnia, Pul HTN / RV dys ( except LVRS lung volume reduction sx in severe emphysema)

Question 6

DLco and less than ___% equals poor prognosis for lung cancer resection

Answer 6

diffusion capacity or transfer factor of lung for CO. if DLCO less then 60% then = poor prognosis

Question 7

Vo2 Max

Answer 7

The maximum rate of oxygen consumption measured during incremental exercise. rate at which mitochondria can reduce oxygen in the process of oxidative phophorlyation. Vo2 Max =
maximum milliliters of oxygen consumed in 1 minute ________________________________
body weight in kilograms

Question 8

RVH EKG signs

Answer 8

negative in 1 more positive in III, also tall R waves in V1 V2

Question 9

Five thoracic sx goals

Answer 9

Narcosis and analgesia, suppress airway reactivity, minimize interference with protective reflexes, maintain blood exchange and cardio stability, rapid elimination of anesthetics

Question 10

DLT size male

Answer 10

37-39 Fr

Question 11

DLT size female

Answer 11

35-37 Fr

Question 12

Positioning for thoracic sx

Answer 12

lateral decubitus, bean bag, kidney rest?, axillary roll always

Question 13

max inflation during taping of chest timing?

Answer 13

tape during inspiration

Question 14

Fluids for thoracic sx

Answer 14

limit to 10-15mL/kg. Risk RV failure and pul edema.

Question 15

Before chest closure for thoracic sx what will surgeon say…

Answer 15

inflate gave recruitment breaths 20-30cmH20

Question 16

to facilitate closure (wire twisting) you will have to…

Answer 16

return table to flat or exert pressure on the up shoulder

Question 17

Zone 1 is deadspace or shunt
Zone 2 is deadspace or shunt
Zone 3 is deadspace or shunt

Answer 17

1 = deadspace 
2= normal
3= shunt

Question 18

Dependent vs nondependent lung % BF

Answer 18

55% vs 35 % and 10% is shunted

Question 19

Trachea bifurcates at

Answer 19

t5

Question 20

angle of right and left bronchus

Answer 20

25 and 45

Question 21

right lobe vs left lobe # and upper lobe disstance to carina

Answer 21

3 upper lobe 1.5-2 cm vs 2 upper lobe 5cm

Question 22

Hypoxic pulmonary vasoconstriction functions best when ____% is hypoxic

Answer 22

30-70%. more than 70 then no where to shunt and 30% no enough hypoxic to shunt from

Question 23

What Tv do we want for just dependent lung?

Answer 23

8-10 mL/kg

Question 24

Hypoxic thoracic lung case

Answer 24

add peep then passive oxygenation. last resort can clamp pul artery

Question 25

Awake intubation
sedation & analgesia
use lido + epi or phenylephrine
—4% lidocaine through mask needs to wait

Answer 25

.4 glyco or .4 atropine
precedex and ketamine?
reduces bleeding
20-30 mins

Question 26

why is IM better than IV for atro and glyco for awake intubation

Answer 26

less tachy

Question 27

for superior laryngeal block nerve passes __mm inferior to greater normu of hyoid bone

Answer 27

2-4MM