surgical intervention

Question 1

what are the thoracic surgical procedures

Answer 1

• thoracentesis
• Bullectomy
• Lung volume reduction surgery (LVRS)
• Video assisted thoracoscopy
• Lung transplants

Question 2

what is Thoracentesis

Answer 2

aspiration of fluid due to pleural effusion

Question 3

what is a diagnostic thoracentesis

Answer 3

sampling of a pleural effusion using a needle through the chest wall, is a simple procedure done to look for the cause of a pleural effusion

Question 4

what is bullectomy

Answer 4

Removal of giant bullae

Question 5

what is the contraindication of bullectomy

Answer 5

Substantial homogenous emphysema

Question 6

indication of bullectomy

Answer 6

• Severe functional limitations
• Non smoker
• Bulla >1/3 hemithorax
• RV with normal DLco, PaCO2 & O2

Question 7

what is LVRS?

Answer 7

remove diseased, emphysematous lung tissue

Question 8

what is the mechanism of LVRS

Answer 8

decrease volume leads to decrease hyperinflation leads to “unflattening” the diaphragm therefore
improved
-  elastic recoil
-  V/Q
- respiratory muscle function
- right ventricular filling

Question 9

what is Endobronchial valve

Answer 9

1 way valve placed in area distal to emphysema lung unit, that only allows air to exit during exhalation

Question 10

what is bronchial bypass stent

Answer 10

connecting a heatlhy and emphysemic portion of the lung via a bronchial bypass allowing exhalation of gas through the healthy one

Question 11

purpose of VATS

Answer 11

Insertion of thoracoscope through the
chest wall

Helpful in the diagnosis of:

• Tuberculosis
• Mesothelioma
• Metastatic cancer

Question 12

which lung transplant is preferred?

Answer 12

Generally, those with double lung manage
better over the long term, therefore this is
preferred

Question 13

in what disease is single lung transplant sucessful

Answer 13

Pulmonary Fibrosis, COPD, and PPH

Question 14

why is double lung transplant used for CF

Answer 14

if use single lung, the native lung will infect the new lung

Question 15

What is the minimum criteria for neurological determination of death

Answer 15

1. positive apnea test , 2 doctor need to confirm patient is brain dead
2. Absent of brain stem reflexes
   –> absent gag and cough
   –> bilateral absent of
   — Motor responses (babinski, knee jerk) excluding spinal reflexes
   —corneal responses
   — pupillary responses to light
   with pupils at mid size or
   greater and
   —vestibulo ocular response

Question 16

what is the confounding factor of false positive indication of brain death

Answer 16

Unresuscitated shock
Hypothermia (<34C)
Severe metabolic disorders
CNS depressants, muscle relaxants
Clinically significant drug intoxications
(including Post resuscitation phase

Question 17

how is the apnea test done

Answer 17

1. Pre oxygenate with 100% oxygen
   - ->oxygen is administered without ventilation mechanically
   - -> 6 lpm by cannula via high flow system
2. establish baseline ABG
   - -> PaCO2 is 35-45 mm Hg, and pH is 7.4 or less
3. observe for Observe for spontaneous respirations
4. after After 10 minutes draw an arterial blood
   sample.

Question 18

How to determine a +ve test

Answer 18

• PaCO 2 is >60mm Hg and 20mmHg rise and
• pH is 7.28 or less, and
• no respiratory effort noted

Question 19

how to optimize mechanical ventilation of donors lung

Answer 19

FiO2 to keep SaO 2 > 95% & PaO2 more or equal 80mmHg

8-10ml/kg
pip: less than or equal to 30
PaO2/Fio2 ratio, less than 300 
if any difficult acquiring these values, do positioning therapy or chest physiotherapy, suctiooning 
increase peep to 15 to recruit

Question 20

why is bronchscopy and anitbodies performed to manage donor lung

Answer 20

risk of infection and bleeding