Soft tissue surgery (respiratory) Flashcards
what are some possible effusions that can occur in the thorax?
pyothorax
chylothorax
haemothorax
serosanguinous effusions
neoplastic effusions
what are some contraindications for draining the thorax?
if patient isn’t stable
ongoing haemothorax (trauma/coagulopathy)
clinically insignificant volume
what are the features of a normal pleural cavity?
mesothelial lining
potential space in thoracic cavity
small volume of pleural fluid (lubrication)
what is lung collapse also known as?
atelectasis
what are the clinical signs of a pleural effusion?
restrictive/paradoxical breathing
tachypnoea, dyspnoea, cyanosis
orthopnoic posture
diminished cardiac sounds
what will happen if a pleural effusion if percussed?
lung sounds decrease dorsally due to fluid
what are the possible ways to drain the thoracic cavity?
needle thoracocentesis
trocar thoracostomy tube
wire guided multi-fenestrated thoracostomy
where is needle thoracocentesis carried out?
7th to 9th intercostal space (dorsal for air and ventral for fluid)
cranial aspect of rib
should the three tap be on or off when inserting for needle thoracocentesis?
off
what are some possible complications of needle thoracocentesis?
lung lacerations
pneumothorax
haemorrhage
iatrogenic infection
what angle should the needle be inserted for needle thoracocentesis?
parallel to chest wall once through it (reduce risk of lung laceration)
how can you test if blood from needle thoracocentesis is due to iatrogenic haemorrhage or haemothorax?
it will clot if its from iatrogenic haemorrhage
when are thoracostomy tubes placed?
if repeated thoracocentesis is required
following thoracic surgery
to medically manage pyothorax
what recumbency is best for inserting a thoracostomy tube?
lateral
where is a thoracostomy tube inserted?
through 7th/8th intercostal space on cranial border of rib
where is an incision madd when placing a trocar type chest drain?
over 10th/11th intercostal space and then inserted between the 7th or 8th intercostal space
what post-placement care is needed for thoracostomy tubes?
close monitoring (respiratory rate, effort, insertion site…)
hard elizabethan collar and body vest
analgesia
what are some possible complications associated with thoracostomy tubes?
discharge around tube site
damage/removal - pneumothorax
tube blocking/kinking
pain
intra-thoracic structure damage
when should a thoracostomy tube be removed?
when draining <2ml/kg/day of fluid
depending on patient status, disease and diagnostic imaging
how would the blood supply of the trachea be described?
segmental from thyroid and bronchoesophageal artery
what nerve innervates the trachea?
right vagus nerve
how is the cervical trachea approached for surgery?
patient in dorsal recumbency with the neck straight
ventral midline incision from caudal to the larynx
separate sternohyoideus muscle on the midline
why may patients undergoing tracheal surgery have post-surgical laryngeal paralysis?
recurrent laryngeal nerves run very close to the trachea
what suture material is used to close the trachea?
absorbable monofilament
what suture pattern is used to close the trachea?
simple interrupted pattern with knots placed extraluminally
what are the indications for a temporary tracheostomy tube?
life threatening upper airway obstruction - BOAS, laryngeal paralysis, laryngeal foreign bodies, neoplasia
GA for intra-oral surgery
how do temporary tracheostomy tubes need to be managed?
ICU (24 hour monitoring)
replace tube twice daily
keep tubes clean (fill with mucous)
what are the possible complications of temporary tracheostomy?
plugging of tube
accidental removal
gagging/coughing
infection
stenosis
pneumothorax/pneumomediastinum
how do you determine if you can remove the temporary tracheostomy tube?
occlude before removal to see how they cope
what ate the indications for tracheal resections and anastomosis?
trauma, stenosis, neoplasia, avulsion
what is the maximum length you can remove for trachea resection/anastomosis?
5-6 rings
what does tracheal collapse result from?
laxity of the trachealis muscle causing weakness of the trachea rings leading to collapse of the lumen
what dogs are predisposed to tracheal collapse?
middle aged small/toy breeds
what are the clinical signs of tracheal collapse?
goose-honk cough
dyspnoea
exercise intolerance
cyanosis
what is a grade 1 tracheal collapse?
laxity of dorsal tracheal membrane leading to 25% luminal collapse
what is a grade 2 tracheal collapse?
loss of cartilage rigidity and further laxity leading to 50% collapse
what is a grade 3 tracheal collapse?
flattening of the carriage leading to 75% collapse
what is a grade 4 tracheal collapse?
100% loss of luminal integrity
what is used to medically manage tracheal collapse?
corticosteroids (anti-inflammatory)
anti-tussives
bronchodilators
antimicrobials (if infected)
weight loss
exercise control (use harness)
how can tracheal collapse be treated surgically?
extraluminal prosthetic tracheal rings
intraluminal stenting (continue medically management)
what is the disadvantage of an intercostal thoracostomy?
can only access one side of the trachea
how is a median sternotomy carried out?
position in dorsal recumbency and approach through cutting through the sternum
what are the indications for a lung lobectomy?
lung lobe torsion
localised pulmonary abscess, cyst, neoplasia…
severe lung trauma
broncho-oesophageal fistula
how are rib fractures treated?
usually incidental - analgesia and oxygen
what is flail chest?
segment of one or more ribs is fractured in two places so this segment moves independently from the chest 9causes paradoxical moving)
how is flail chest treated?
stabilising surgically (external brace) - only if respiratory function is compromised
where do tears of the diaphragm most commonly occur?
ventrolateral part of the diaphragm
how are diaphragmatic hernias treated?
surgery when patient is stable (ASAP if stomach has herniated)
midline coeliotomy and close with absorbable monofilament
