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Y4 SA - Soft tissue surgery > Surgery of the respiratory tract > Flashcards

Surgery of the respiratory tract Flashcards

1
Q

The trachea is innervated by which nerve?

A

Right vagus nerve

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2
Q

Which diagnostic methods can be used to investigate the trachea?

A
  • Clinical examination
  • Radiography
  • Computed Tomography
  • Fluoroscopy dynamic assessment
  • Trancheobronchoscopy dynamic assessment
  • Tracheal wash/bronchoalveolar lavage
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3
Q

Describe the surgical approach to the cervical trachea

A
  • Dorsal recumbency + straight + neck extended over a sandbag
  • Ventral midline longitudinal incision from caudal to larynx
  • Separate the sternohyoideus muscles – stay on midline
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4
Q

Which structures must be avoided when surgical approaching the trachea?

A

Segmental blood supply
Recurrent laryngeal nerves

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5
Q

Describe the surgical approach to the thoracic trachea

A

(very few indications)
- First part: via cervical approach and cranial retraction + cranial median sternotomy
- Median sternotomy or right 3rd to 5th intercostal thoracotomy
REFER

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6
Q

Describe surgical closure of the trachea (materials, pattern etc)

A
  • Absorbable monofilament suture material
  • Simple interrupted pattern
  • Knots placed extraluminally
  • Careful apposition of mucosa + gentle handling for optimal healing
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7
Q

When is a temporary tracheostomy indicated?

A
  1. Life-threatening upper airway obstruction
    - BOAS
    - Laryngeal paralysis
    - Laryngeal foreign bodies
    - Neoplasia
  2. For GA administration when intra-oral surgery is performed
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8
Q

When is a temporary tracheostomy contra-indicated?

A
  • Obstruction distal to the tracheostomy site
  • Tracheal collapse distal to the tracheostomy site
  • Previous tracheal stent placement
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9
Q

What equipment is found in a temporary tracheostomy kit?

A
  • Surgical instruments
  • Tracheostomy tubes, uncuffed / cuffed
  • Large suture material (stay sutures)
  • Umbilical tape
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10
Q

Describe the procedure for a temporary tracheostomy

A

Transverse incision between rings (3-4 or 4-5) should not exceed 50% of tracheal circumference

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11
Q

Describe the management of a temporary tracheostomy

A
  • ICU 24hr monitoring
  • Replace tube at least twice daily: once the air isn’t warmed by the URT, the cold air within the trachea increases mucous production for about 16 weeks. Need to keep tubes clean to provide a patent airway
  • Suction (few seconds; risk of bradycardia)
  • 0.2mL/kg of STERILE saline down the tube q4hrs or nebulise
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12
Q

Why do patients with a temporary tracheostomy require 24hr monitoring?

A

Tracheostomy tubes can block or dislodge -> suffocation

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13
Q

List the potential complications that can occur following a temporary tracheostomy

A
  • Plugging of tube
  • Tube removal
  • Gagging, coughing
  • Subcutaneous emphysema, pneumomediastinum, pneumothorax
  • Infection
  • Stenosis
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14
Q

When is a permanent tracheostomy used?

A

Salvage procedure – unresolvable upper airway obstruction
Tracheal mucosa to skin
- Owners have to be very committed to looking after these patents long term

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15
Q

List the 4 indications for tracheal resection and anastomosis

A

Trauma
Stenosis
Neoplasia
Avulsion

No more than 5-6 rings

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16
Q

What are the 3 main complications of tracheal resection and anastomosis?

A

Air leakage
Infection
Stricture

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17
Q

Describe some other conditions of the trachea

A

Rupture - cats, over inflation of ET tube, subcutaneous emphysema
Avulsion - cats
Hypoplasia - BOAS
Stenosis
Neoplasia - rare

18
Q

How does tracheal collapse occur?

A

Laxity of trachealis m. > weakness of rings > collapse

19
Q

In which patients is tracheal collapse most commonly seen?

A

Middle-aged small/toy breeds

20
Q

How would a patient with a tracheal collapse present?

A

‘Goose-honk’ cough, dyspnoea, exercise intolerance, cyanosis

21
Q

List the diagnostic methods for tracheal collapse

A

Signalment
History
Clinical signs
Thoracic radiography
Tracheoscopy
Fluoroscopy

22
Q

Describe the different grades of tracheal collapse

A

Grade 1 = laxity of the dorsal tracheal membrane, 25% luminal collapse
Grade II = loss of cartilage rigidity and further laxity, 50% luminal collapse
Grade III = flattening of the cartilages, 75% collapse
Garde IV = 100% loss of luminal integrity

23
Q

How can tracheal collapse be managed medically?

A
  • Corticosteroids (anti-inflammatory) - Oral or inhaled
  • Anti-tussives
  • Bronchodilators
  • Antimicrobials: if infection, choose based on BAL if possible
  • Weight loss
  • Exercise control: harness
24
Q

Describe the emergency management of a patient with tracheal collapse

A
  • Oxygen
  • Sedatives
  • Corticosteroids
  • Intubate
  • Check if correction of laryngeal paralysis/collapse or staphylectomy needed
25
Q

How is tracheal collapse treated surgically?

A

Extraluminal prosthetic tracheal rings
Intraluminal stenting

26
Q

List some complications of tracheal collapse surgery

A
  • Stent fracture
  • Stent migration
  • Inflammatory tissue
  • Necrosis
27
Q

Describe an intercostal thoracotomy

A
  • Access to R or L thorax
  • Cannot access structures away from incision
28
Q

Describe a median sternotomy procedure

A

Bilateral exploration of the thoracic cavity
Preserve manubrium or xyphoid if possible

29
Q

List the 4 indications for a lung lobectomy

A

Total or partial lobectomy
- Lung lobe torsion
- Localised pulmonary abscess, cyst, bulla, neoplasia
- Severe lung trauma
- Broncho-oesophageal fistula

30
Q

What are the 3 main aims of managing a patient with thoracic trauma (RTA, bite wound, fall, etc)?

A
  • Maintain a patent airway, provide oxygen
  • Support circulation – iv access - fluids
  • Control obvious haemorrhage
31
Q

List the 7 common injuries associated with thoracic trauma

A
  • Pulmonary contusions
  • Pneumothorax
  • Rib fractures
  • Open thoracic wounds
  • Haemothorax
  • Diaphragmatic rupture
  • Shock
32
Q

What should be assessed when examining a patient with thoracic trauma?

A
  • Respiratory rate and pattern
  • Mucus membrane colour and CRT
  • Auscultation and percussion of thorax
  • Observation of thoracic outline
  • Check for evidence of wounds
  • Minimise patient stress
33
Q

Which diagnostic tests would you want to perform in a patient with thoracic trauma?

A
  • Haematology, serum biochemistry
  • Radiography: thoracic (lateral/DV, not VD!), abdominal
  • Thoracocentesis if pleural air or fluid
34
Q

Describe how to treat rib fractures

A
  • Often incidental findings on radiographs
  • Suspect pulmonary contusions present if recent trauma
  • Conservative management usually adequate
  • Analgesia
  • Rest
  • Oxygen supplementation
35
Q

Describe a flail chest

A
  • Segment of one or more ribs is fractured in two planes
  • This segment can move independently from chest wall
  • Paradoxical movement compromises respiration
36
Q

What is a diaphragmatic hernia?

A

Direct or indirect injury > abdominal organs enter pleural space

37
Q

List the organs involved in a diaphragmatic hernia from most to least likely

A

Liver; SI > stomach > spleen > omentum > pancreas > colon > coecum > uterus

38
Q

Describe the signs presented with a diaphragmatic hernia

A

Pleural effusion
Respiratory and gastrointestinal signs
Exam: normal? Empty abdomen? Muffled heart sounds? Borborygmi on auscultation?

39
Q

Describe surgery for a diaphragmatic hernia

A
  • Surgery when the patient is stable!
  • Surgery asap if stomach herniated: needle decompression to reduce gas expansion
  • Chronic consider no treatment ?
  • Gradual re-expansion of lungs, otherwise reperfusion injury and pulmonary oedema
  • Diaphragmatic closure: PDS (absorbable monofilament) in a simple continuous +/- interrupted pattern
40
Q

Describe loss of domain during diaphragmatic hernia surgery

A

Suddenly too much content within the abdomen – may need to consider splenectomy

Y4 SA - Soft tissue surgery (8 decks)

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