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Personal CV > Thoracic Procedures > Flashcards

Thoracic Procedures Flashcards

1
Q

Pulmonary function high risk indicators?

A
  • FVC 50%

- Diffusing capacity 45

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2
Q

What would FVC, FEV1, FEV1/FVC, and RV/TLC look like in a intrinsic restrictive patient?

A
  • FVC = Decreased
  • FEV1 = Normal
  • FEV1/FVC = Normal
  • RV/TLC = Normal
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3
Q

What would FVC, FEV1, FEV1/FVC, and RV/TLC look like in a extrinsic restrictive patient?

A
  • FVC = Decreased
  • FEV1 = Normal
  • FEV1/FVC = Normal
  • RV/TLC = Increased
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4
Q

What is the difference between Obstructive and restrictive lung diseases?

A
  • Obstructive is difficulty exhaling

- Restrictive is difficulty fully expanding lungs with air

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5
Q

What would FVC, FEV1, FEV1/FVC, and RV/TLC look like in an obstructive lungs disease like asthma, bronchitis, or emphysema?

A
  • FVC = Normal
  • FEV1 = Decreased
  • FEV1/FVC = Decreased
  • RV/TLC = Increased
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6
Q

What is generally the presenting problem with patients with Pulmonary HTN, RVH, or Cor Pulmonale?

A

-Right heart failure

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7
Q

Right heart failure signs and symptoms

A
  • Dependent edema
  • Large, tender liver
  • Ascites
  • Dilated neck veins
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8
Q

What 3 things would appear in a CXR of pulmonary HTN?

A
  • Pulmonary vessel dilation
  • COPD
  • RVH
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9
Q

What are the main LV dysfunction contributors?

A
  • Hypoxia
  • Hypercarbia
  • Hypertension
  • acidosis
  • Alterations in intrathoracic pressure
  • CAD
  • Valve disease
  • Ventricular Interdependence
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10
Q

What 4 things should be addressed in preop?

A
  • Stop smoking
  • Breathing exercises
  • Bronchdilation
  • Weight reduction
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11
Q

What meds can be used for bronchodilation?

A
  • Aminophylline
  • Cromolyn sodium
  • Parasympatholytics
  • Sympathomimetics
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12
Q

Thoracic surgery intraop goals

A
  • Minimize anesthesia time
  • Control secretions
  • Prevent aspiration
  • Bronchodilation
  • Intermittent hyperinflation
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13
Q

Thoracic surgery postop goals

A
  • Mobilize secretions
  • Early intubation
  • Cough and deep breathe
  • Analgesia
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14
Q

Name 3 sympathomimetics

A
  • Metaproterenol
  • Albuterol
  • Terbutaline
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15
Q

How does a sympathomimetic work?

A

-Beta agonist that increases cAMP = bronchodilation

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16
Q

Name 2 parasympatholytics

A
  • Atropine

- Ipratropium vromide

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17
Q

How do parasympatholytics work?

A

-Decrease cGMP = inhibits bronchodilation

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18
Q

Name a phosphodiesterase inhibitor?

A

-Aminophylline

19
Q

How do phosphodisterase inhibitors work?

A

-inhibit breakdown of cAMP

20
Q

How do steroids work and name one.

A
  • Reduce mucosal edema and suppress inflammation

- Beclomethasone

21
Q

How does cromolyn sodium work?

A

-Mast cell stabilizer which prevents histamine release

22
Q

When would you use digitalis?

A
  • Left sided heart failure

- SVT or rapid ventricular response

23
Q

When would prone position be used?

A
  • Prevent flooding to tracheobronchial tree
  • TB
  • Pulmonary abcess
24
Q

What is the standard thoracotomy position?

A

Lateral decubitis

25
Q

How is ventilation and perfusion effected in the lateral decubitus position? And which happens first?

A
  • Dependent lung is better perfused (first)

- Independent lung is better ventilated

26
Q

What are the advantages of lateral decubitis?

A
  • Complete access hemithorax
  • Length of incision can be increased
  • Patient easily tilted
  • Safest for hilar
  • Control of hilar vessels
27
Q

Disadvantages of lateral decubitis

A
  • Opposite hemithorax inaccessible
  • V/Q mismatch
  • Contamination of dependent lung
  • Decreased FRC, airway closure, and atelectasis of dependent lung
28
Q

How can you separate the lungs?

A
  • Double lumen tube
  • Univent ETT
  • Bronchial blocker
29
Q

3 reasons to separate the lungs?

A
  • Prevent cross lung contamination
  • Redistribute ventilation
  • Unilateral bronchopulmonary levage
30
Q

Indications to separate the lungs?

A
  • Exposure for:
  • -Thoracic aortic aneurysm
  • -Lobectomy
  • -Pneumonectomy
  • -Esophageal resection
  • -Subsegmental resection
31
Q

Increased risk of death during thoracotomy?

A
  • Cardiopulmonary disease
  • Obesity
  • Advanced age
  • Tumor
  • Pericardial involvement
  • Pulmonary HTN
32
Q

What should be avoided in GA and one lung ventilation?

A
  • N2O

- Hypoxia

33
Q

Steps when hypoxia on one lung ventilation?

A
  • 100% O2
  • ABG
  • Check placement w/ fiber optic
  • May need to reinflate lung
  • CPAP to independent lung
  • PEEP if CPAP fails
  • Clamp pulmonary artery
34
Q

Contraindications to DLT?

A
  • Lesions along tube pathway
  • Difficulty obtaining direct vision intubation
  • Critically ill patient can’t tolerate apnea
  • Full stomach
35
Q

Things to worry about with bronchoscopy?

A
  • Sharing airway w/ surgeon
  • Arrhythmias
  • Hypertension
  • Hypoxemia
36
Q

Rigid bronchoscopy tidbits.

A
  • Glyco early to dry up secretions
  • Topical
  • Short acting drugs
  • Light sedation
37
Q

When is a fiberoptic bronch used?

A

-Eval of tracheobronchial tree deeper than rigid

38
Q

Contraindications to bronchoscopy?

A
  • Unstable CV
  • Life threatening arrhythmias
  • hypoxemia
39
Q

Problems encountered during bronchoscopy?

A
  • Coughing
  • HTN
  • Tachycardia
  • Bleeding my require lung seperation
40
Q

Indications for pneumonectomy

A
  • Non-small cell lung CA
  • Drug resistant TB
  • Trauma
  • Myobacterium
  • Fungal infection
  • Necrosis
41
Q

What is eaton lambert syndrome?

A
  • Muscle wasting

- May influence muscle relaxant choice

42
Q

Chest tubes are clamped to prevent what?

A

-Mediastinal shifts

43
Q

Ipsilateral mediastinal shift problems?

A
  • Hypotension
  • arrhythmias
  • cardiac herniation
  • Pulmonary edema
44
Q

Contralateral mediastinal shift signs?

A
  • Decreased lung function

- decreased venous return

Personal CV (8 decks)

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