Thoracic cavity Flashcards
What is a thoracotomy?
Opening up the thorax
What are the steps of a thoracotomy?
6 steps
- Incising skin between IC spaces
- incise subQ
- incise cutaneous tunci muscle
- deepen into latissimus dorsi with scissors
- transect pecs, serratus ventralis, scalenus and IC muscles
- retract with Finochietto retractors
What findings on radiology for pneumothorax? (3 findings)
Air between pleura and abdominal wall see as radiolucent (black) spaces
Collapsed lung tissue (acelectasis) seen as consolidated radiopaque lung tissue
Heart lifted away from the sternum (dorsally)
What are the indications for practicing chest operation (thoracotomy)?
Access to any thoracic organs;
Trachea (Tracheotomy, tracheostomy)
Thoracic oesophagus (Oesophagotomy, oesophagostomy)
Heart (persistant 4th aortal arch)
Lungs (Lobectomy)
Hiatal hernias
Trauma (penetrating or non-penetrating) e.g. Broken ribs, Flail chest
Pneumo,chylo,heamo,hydro – thorax (Result of trauma, iatrogenic or spontaneous)
What suture patterns are used for chest? and How are they placed?
Interrupted circumcostal sutures
placed midway in the IC space to avoid damage to the vessels and nerves that run on the caudal rib boarder. Placing midway allows the IC muscles to act as cushions between the suture and the vessels/nerve
What are the steps for closing after thoracotomy operation?
Muscle layers are closed individually with simple interrupted absorbable suture
Skin is closed in a regular fashion
Closure must be hermetic
Using a thoracostomy tube you will leave in the thorax you must drain air from the cavity until negative pressure is achieved
Types of thoracotomy? (3)
Right or left intercostal thoracotomy
midline sternotomy
lateral (transcostal) thoracotomy
What is a pneumectomy?
removal of one side of the lungs
Aetiology of pneumothorax?
Open - pleurocutaneous
Close - pluerooesophageal or pleuropulmonar
Both can be caused by trauma, iatrogenic or can be idiopathic (spontaneous)
Air enters the thorax but cannot leave
2 localisations of tracheal collapse
Cervical - collapse during inspiration
Thoracic - collapse during expiration
How to remove air from the thoracic cavity?
Thoracocentesis
(Hollow needle or catheter placed in the 6-8 IC space between the pleura and the lungs. Local anaesthesia or a nerve block can be done as analgesia)
suck air until there is less than 2ml/kg BW
How to Dx tracheal collapse? (3)
Palpation
Endoscopy
X-Ray
Non-specific Cx (cough, dyspnoea, afebrile)
Thoractomy according to localization of organs
Heart (PDA – 4/5 ,VCCau – 6/7)
Lungs (4/6)
Oesophagus (Cranial – 3/4, Caudal – 7/9)
What is therapeutic approach to impaling objects in the thoracic cavity?
Medical: ATB’s, O2, positioning the animal with the affected side down (stabilises broken rib segment)
Surgical: Debride outter tissue, attain negative pressure, thoracotomy only indicated in bites or when X-Ray shows >3 lesions. Broken ribs usually heal on their own but multiple may require setting
2 types of tracheal collapse? (not localisations but aetiology)
Congenital - inherited
Acquired - trauma
