Thoracic Surgery Flashcards
1
Q
define atelectasis
A
collapsed or underinflated lung
2
Q
define centesis
A
sampling of fluid
3
Q
define hernia
A
passage of organ/tissue through a normal opening in the body
4
Q
define exudate
A
pus
5
Q
define flange
A
side tabs that allow for simple suturing of narrow bore chest drains to skin
6
Q
define hyperpnoea
A
increased breathing effort
7
Q
define hypoventilation
A
reduced oxygen exchange within the lungs
8
Q
define hypoxaemia
A
low O2 in the blood
9
Q
define ipsilateral
A
the same side
10
Q
define modified transudate
A
fluid formed by leakage from normal/non-inflamed vessels (high protein content)
11
Q
define orthopnea
A
where an animal adopts a particular positional orientation in order to breathe - often sternal with forelimbs, head and neck extended
12
Q
define parenchymal
A
tissue of an organ (not including connective tissue)
13
Q
define radiolucent
A
transparent to x-rays
14
Q
define radioopaque
A
xrays cannot pass though
15
Q
define tachypnoea
A
more rapid breathing than normal
16
Q
define TFAST
A
thoracic focussed assessment with sonography for trauma
17
Q
define pure transudate
A
passive fluid accumulation
18
Q
how may signalment affect the assessment of thoracic conditions?
A
age, species and breed, lifestyle can all predispose patients to different diseases
19
Q
what thoracic disease is more often seen in older animals?
A
neoplasia
20
Q
what thoracic condition are cats predisposed to?
A
mediasteinal masses
21
Q
what thoracic condition are yorkies predisposed to?
A
tracheal collapse
22
Q
what thoracic condition are pugs predisposed to?
A
lung lobe torsion
23
Q
what thoracic condition are afgans predisposed to?
A
chylothorax
24
Q
what thoracic condition are ESS predisposed to?
A
lung FB
25
what must be considered when assessing a patient with thoracic disease?
signalment
onset (acute or chronic)
progression (slow or rapid)
26
what are the clinical signs that may raise suspicion of thoracic conditions?
tachypnoea
abnormal breathing
cough
pale mm or cyanosis
exercise intolerance
collapse
may have injuries
may be systemically unwell
27
what abnormal breathing may be seen with patients with thoracic conditions?
orthopnoea
hyperpnoea
dyspnoea
abdominal breathing
28
is a cough always seen with thoracic conditions?
no
29
what is involved in the preliminary management of patients with thoracic conditions?
minimise deterioration
monitor patient closely
30
what is the key area involved in minimising deterioration of patients with thoracic conditions?
oxygen
31
what should be involved in the monitoring of patients with thoracic conditions?
recording every 5-10 minutes initially
assessing for any upward or downward trends
32
is there any downside to providing oxygen to patients with thoracic conditions?
no - just expensive!
33
what are the options for O2 administration?
flow by
nasal cannula
face mask
oxygen collar
oxygen cage
intubation
34
what aids the decision around what oxygen delivery method to use?
patient stress levels and how much handling they can cope with
35
what should be done with any wounds seen on thoracic patients?
assess and record
flush if contaminated
protect from ongoing damage
36
why may it be necessary to assess the temperament of patients with thoracic conditions?
deciding on O2 delivery
would mild sedation be of benefit
37
why is it essential to monitor progression of thoracic patients?
identification of trends according to treatment being given
status of these patients can change quickly
38
what diagnostics should be prepared for for thoracic patients?
bloods
thoracocentesis
imaging
39
what must be considered when imaging a patient with thoracic disease?
restraint for radiography can be life threatening as the patient may not be able to breathe in lateral
40
what can be done before the vet arrives to aid prioritisation of case?
TFAST by nurse
41
what is essential when performing thoracocentesis?
ensure all samples are taken before placing any fluid into non-sterile dishes
42
what imaging may be needed for thoracic patients?
xray
ultrasound
or both
43
what should be considered about imaging modality of thoracic patients?
radiography of dyspnoeic patients may be dangerous
ultrasound can rpovide a vidio
44
what can be identified on thoracic imaging?
pneumothorax
pleural effusion
foreign bodies
soft tissue masses
trauma
45
what are the main presentations of pneumothorax?
unilateral or bilateral
small or large volume
may be open or closed
46
is thoracocentesis required for pneumothorax?
yes
47
what are the main presentations of pleural effusion?
unilateral or bilateral
small or large volume
48
is thoracocentesis required for pleural effusion?
yes - samples needed
49
how may foreign bodies be identified on imaging?
may be radiolucent or radioopaque
50
what would indicate neoplasia on xray?
normal structures in the thorax with abnormal appearence
51
what would indicate torsion on xray?
normal structures in the thorax with abnormal appearence
52
what would indicate diaphragmatic hernia on xray?
abnormal structure in thorax
53
what may be seen on imaging of trauma patients?
broken ribs
may or may not have broken skin
diaphragmatic hernia
54
what is flail chest?
whole section of ribs broken on both ends which then moves with the lung during breathing and can cause trauma
55
what are the main surgical thoracic conditions?
pneumothorax
chest and lung trauma
pulmonary blebs and bullae
diaphragmatic rupture
pleural effusion
pyothorax
pericardial effusion
pulmonary neoplasia
56
is pneumothorax always accompanied by obvious trauma?
no
57
what approach is used for diaphragmatic rupture surgery?
abdominal
58
what are the reasons for pleural effusion?
many - CHF, FIP
59
what types of fluid are seen in pleural effusion?
many e.g. transudates, exudates, blood, chyle
60
what is pyothorax?
pus in the chest
61
what is pericardial effusion?
fluid around the heart that may accumulate over time or acutely
62
why is sampling essential for pleural effusion?
many different causes
63
what are the two types of pneumothorax?
internal or closed
external or open
64
what is an internal or closed pneumothorax caused by?
leak caused by something inside the chest
65
where may a closed pneumothorax originate from?
oesophagus
respiratory tract (trachea or small airways)
66
how does the presentation of open and closed pneumothorax differ?
internal or open is more rapid and become sicker quicker
67
how can an open or external pneumothorax be identified?
more obvious due to hole in chest
68
what can open or external pneumothorax be caused by?
chest trauma
iatrogenic
69
what are the iatrogenic causes of open pneumothorax?
lung lobectomy
diaphragmatic rupture
complications of thoracocentesis or throacostomy
70
what are the clinical signs of pneumothorax?
dyspnoea
lethargy
cough
exercise intolerence
71
how is pneumothorax diagnosed?
imaging
thoracocentesis
72
why may unilateral pneumothorax lead to bilateral?
if pressure in one side of the chest increases enough the mediasteinum could rupture and air could flood both sides
73
why may bilateral chest drains be needed for bilateral pneumothorax?
if mediasteinum is intact
74
how is pneumothorax treated?
chest drain
thoracotomy
75
when is a chest drain used to treat pneumothorax?
conservative management if air leak may spontaneously heal
76
when is a surgery used to treat pneumothorax?
if air leak is massive or if ongoing and not sealing
77
how may chest and lung trauma be caused?
accident (RTA/cliff)
attack (dog, human)
78
what should be done if you suspect trauma to a patient was non-accidental?
reporting following practice policy
79
what are the clinical signs of chest/lung trauma?
shock
dyspnoea
soft tissue damage
ortho damage eg. rib fracture
80
what affects the prognosis of patients with chest and lung trauma?
soft tissue and ortho damage
81
what types of soft tissue damage may be seen with chest and lung trauma?
open and may be extensive
bruising or crush injuries which progress
82
what ortho damage may be seen with chest and lung trauma?
rib fractures including flail chest
other fractures round the body whcih may complicate patient management
83
how should patients with chest and lung trauma be managed?
stabilised before surgery with oxygen
84
what are the main complications seen with chest and lung trauma patients?
infection or inflammation
issues with healing
ongoing effusions
pneumothorax
85
what does the prognosis of patients with chest and lung trauma depend on?
severity of injuries - can be costly to treat
86
what can influence risk of infection/inflammation in chest and lung trauma patients?
reason for trauma
degree of contamination
presence of devitalised tissue
87
what are blebs?
bubbles seen on edges of lobes where air has risen to the surface
88
what are lung bullae?
bubbles within lobes where alveoli coalesce
89
what is the signalment for blebs and bullae?
large breed, deep chested dogs
90
what is the cause of blebs and bullae?
unknown
may be some link to underlying disease
91
what clinical signs may be seen with blebs and bullae?
none
non-specific
respiratory
92
when may a patient with blebs and bullae not show clinical signs?
if none have ruptured
93
what non-specific signs may be seen with a patient with blebs and bullae?
lethargy
anorexia
exercise intolerance
94
what respiratory signs may be seen with a patient with blebs and bullae?
sudden onset dyspnoea with no trauma history
progressive tachypnoea, orthopnoea and coughing
95
what is indicated by peracute closed, tension pneumothorax of patients with blebs and bullae?
they ruptured
96
how are blebs and bullae diagnosed?
imaging - xray or CT
97
what is xray useful for in patients with blebs and bullae?
diagnosis of pneumothorax
98
what is xray not useful for in patients with blebs and bullae?
showing which lobes are affected
99
what is CT useful for in patients with blebs and bullae?
assessment of lung lobes are affected so useful before surgery
100
how are blebs and bullae treated?
thoracocentesis with possible chest drain
thoracotomy and lung lobectomy
101
what is involved in surgical treatment of blebs and bullae?
open sternotomy or thorascopy as unsure which lobes are affected
lobectomy if not too many lobes affected
102
how effective is conservative management of blebs and bullae with thoracocentesis or thoracostomy?
only 50% respond
103
where does air accumulate within blebs?
outside or above inner layer of visceral pleura
104
where does air accumulate within bullae?
inside or underneath inner layer of visceral pleura
105
what can cause diaphragmatic rupture?
blunt force trauma (RTA/fall)
106
how does diaphragmatic rupture occur as a result of blunt force trauma?
increased intrabdominal pressure with a closed glottis
diaphragm is weakest structure and ruptures so abdominal contents can move into chest
107
what are the clinical signs of diaphragmatic rupture?
none
vague ill health
dyspnoea or shock
tachypnoea
orthopnoea
108
what may increase the severity of diaphragmatic rupture?
speed of onset of symptoms
degree of herniation
concurrent injuries
109
what may the onset of symptoms of diaphragmatic rupture be like?
peracute
acute
chronic
110
what effect does the degree of herniation have on the severity of diaphragmatic hernia?
organs involved (if any)
any torsion
compression of thoracic contents
size of tear
111
what may improve dyspnoea in diaphragmatic rupture patients?
elevation of thorax to release pressure of abdominal organs on thorax
112
what concurrent injuries may be seen with diaphragmatic rupture?
ortho injuries
113
what is PPDH?
peritoneopericardial diaphragmatic hernia - contents of gut within pericardium
114
when is PPDH seen?
congenital
115
how is diaphragmatic rupture treated?
stabilisation
laporotomy
116
what is involved in stabilisation of patients with diaphragmatic rupture?
O2
analgesia
IVFT
117
what is involved in surgery to manage diaphragmatic hernia?
exploration of chest and abdomen
repositioning of abdominal contents or removal if bad torsion / devitalisation
repair
debride as necessary
118
what must be placed following diaphragmatic rupture repair surgery?
chest drain due to iatrogenic open pneumothorax
119
what may pleural effusion be caused by?
many reasons
120
what are the clinical signs of pleural effusion?
varied
dyspnoea
lethargy
cough
exercise intolerence
121
how is pleural effusion diagnosed?
imaging
thoracocentesis
lab tests
122
what does treatment of pleural effusion depend on?
diagnosis
123
what lab tests may be performed on pleural fluid?
SG
cytology
culture and sensitivity
124
what can specific gravity of effusion samples tell?
what type of fluid it is (e.g. transudate or exudate)
125
what medical conditions may lead to pleural effusion?
CHF
pyothorax
126
how may pyothorax be managed?
conservative management in cats
likely surgical in dogs as conservative is unlikely to work
127
what is pyothorax caused by?
almost always bacterial infection
128
what are the clinical signs of pyothorax?
mild to severe
lethargy
inappectance
PUO
dyspnoea
129
how is pyothorax diagnosed?
labs
imaging
130
what is pyothorax most often caused by in cats?
idiopathic (bites, chronic pneumonia)
131
what is pyothorax most often caused by in dogs?
FB
oesophageal tear
132
what bacteria often causes pyothorax in dogs?
e coli
133
what bacteria often causes pyothorax in cats?
pasturella
134
what lab tests are used to diagnose pyothorax?
cytology
culture
135
how is pyothorax treated?
medical management
sternotomy
136
what is involved in medical management of pyothorax?
systemic antibiotics
chest drain
+/- lavage
137
what animal is conservative management of pyothorax useful in?
cats
138
what is involved in surgical management of pyothorax?
sternotomy to explore chest, remove exudate and flush
139
why is sternotomy for pyothorax done early in dogs?
high percentage of FB
140
what are the main causes of pericardial effusion?
idiopathic in young dogs
neoplastic
141
what do the clinical signs of pericardial effusion depend on?
speed at which fluid forms which is linked to cause of disease as this affects whether the pericardium will have stretched
142
what are the clinical signs of pericardial effusion?
cardiac tamponade
collapse
143
what is cardiac tamponade?
pericardial effusion fills pericardium so heart is unable to expand adequetely
144
how much fluid is seen with idiopathic pericardial effusion?
lots - happens over time so pericardium can stretch
145
how much fluid is seen with neoplastic pericardial effusion?
little - acute onset and so pericardium cannot stretch
146
how is pericardial effusion diagnosed?
radiography
ultrasound (echocardiogram)
advanced imaging
labs
pericardiocentesis
147
what is the purpose of lab analysis of fluid in pericardial effusion?
indicates if there is neoplasia which has poorer prognosis
148
how is pericardial effusion treated?
repeat pericardiocentesis
pericardectomy
chest drain
149
what is the purpose of pericardectomy?
allows fluid to convert to pleural effusion and prevents cardiac tamponade
150
is the creation of pleural effusion through pericardectomy of concern?
no - very little fluid and can be absorbed by pleura
151
what are the complications seen with pericardial effusion?
recurrence after draining and surgery
repair of pericardium as insufficient window taken
adhesions from long standing effusion
152
what is the prognosis of pericardial effusion?
varied due to cause
153
what is the aetiology of pulmonary neoplasia?
malignant more common than benign
secondary more common than primary
154
what are the clinical signs of pulmonary neoplasia?
non productive cough
haemoptysis
dyspnoea
weight-loss
exercise intolerance
anorexia
lameness
none (25%)
155
why is lameness sometimes seen in patients with pulmonary neoplasia?
due to hypertrophic pulmonary osteopathy
156
what is hypertrophic pulmonary osteopathy
paraneoplastic syndrome where new bone forms on extermities due to over production of parathyroid hormone
157
how is pulmonary neoplasia diagnosed?
lab work
imaging
158
what is involved in lab tests for pulmonary neoplasia?
minimum database
+/- cytology
159
what imaging is needed for diagnosis of pulmonary neoplasia?
advanced to see masses under afew mm
inflated x ray for masses over 1cm
160
how is pulmonary neoplasia treated?
palliative care
surgery (open or thoracoscopic)
161
what are the complications associated with pulmonary neoplasia treatment?
as for any thoracotomy
162
what does prognosis of pulmonary neoplasia depend on?
presence of mets
histopathology
surgical margins
163
what is involved in pre and perioperative management of thoracotomy patients?
multimodal analgesia
management of hypothermia
IPPV
164
what should be monitored about the thoracotomy patient post op?
TPR
pain score
165
what is involved in drug choices for thoracotomy patients?
depends on presence of drain / underlying issues
166
what needs very careful management following thoracotomy?
wound and surgical site
drain if present
167
why may body bandages be used on thoracotomy patients?
increased comfort
reduced infection risk
reduced patient interference
168
what nursing care may be required for thoracotomy patients?
assistance with basic functions - DUDE
IVFT
U cath if struggling to mobilise
feeding tubes if anorexic
169
what should be considered if patient is pain scoring high?
basic functions accommodated (e.g. do they need to wee!)
temperament
170
define thoracocentesis
procedure involving the puncture of the pleural space for diagnostic and theraputic purposes
171
what patient prep is needed for thoracocentesis?
sterile skin prep
172
what may be needed to support the patient during thoracocentesis?
oxygen therapy
173
is thoracocentesis a sterile procedure?
yes
174
what does the equipment needed for diagnostic thoracocentesis depend on?
whether plan is for sampling or draining as much fluid as possible
175
what equipment is needed for diagnostic thoracocentesis?
oxygen
short acting local anaesthetic
sterile prep equipment
needle / catheter
assistant
3 way tap
20ml syringe
extension set
kidney dish
176
what medication may be needed for thoracocentesis?
anxiolytic
LA
177
what size butterfly catheter will be needed for thoracocentesis in cats and small dogs?
20/22G
178
what size butterfly catheter will be needed for thoracocentesis in dogs?
18/20G
179
are IV catheters or butterfly needles better for thoracocentesis?
IV catheters mean that the sharp isn't left in the patient's body but the collectin system can only be attached once the stylet is out
butterfly catheters leave a sharp in the patients chest throughout use but can have collection set pre attached
180
what size syringe is needed for thoracocentesis?
small (2ml) for sampling
then larger (20ml) for draining fluid
181
what will syringe size affect during thoracocentesis?
amount of suction applied and speed of aspiration
182
what is essential when collecting samples during thoracocentesis?
samples remain sterile so go straight into sample tubes
183
what samples may be taken during diagnostic thoracocentesis?
EDTA
heparin
plain/serum
culture
cytology - fresh smear and serum
SG
184
what lab equipment is needed for diagnostic thoracocentesis?
refractometer
blood tubes
microscope slides
culture sample tube
185
what is a chest drain?
tube placed into the pleural space to allow ongoing, continuous or intermittent therapeutic drainage
186
what is the decision to place a chest drain based on?
underlying disease and its effect on fluid or air production
quantity of air/fluid produced
patient temperament
treatment plan
187
what can be used for therapeutic thoracocentesis?
butterfly catheter and intermittent drainage
may not be appropriate if frequent or larger volume
chest drain then used
188
why is a chest drain usually placed?
intermittent thoracocentesis not working
following thoracotomy
if long term pleural drainage is needed
trying to avoid surgery
instillation of medication
189
why may intermittent thoracocentesis not work?
too much air or fluid produced
fluid too thick to come through butterfly
too risky - causing lung trauma
190
why is a drain needed following thoracotomy?
removal of fluid / air introduced during surgery
detection of fluid / air produced due to underlying condition
detection of fluid / air produced due to surgical complication
191
when may long term pleural drainage be needed?
pneumothorax due to underlying lung disease
pleural effusion
192
what medication may be placed through a chest drain?
LA
saline
antibiotics
chemotherapy
193
why may saline be placed through a chest drain?
lavage of pyothorax
194
what are the types of chest drain categorised by?
size
placement method
195
what size of chest drains are available?
large bore
narrow bore
196
what are the placement techniques for chest drains?
trocar
seldinger / guidewire
197
what are the main considerations when selecting a chest drain?
type
size
placement method
site
connectors
securing
protection
198
what will inform the type of chest drain used?
material it is draining (air or fluid)
types available in practice
199
what are trocar chest drains made of?
silicone or PVC
200
what does the size of drain depend on?
reason for drainage and amount expected
201
what sizes of chest drain are available?
6Fr to 20 Fr
202
what is french scale?
3x outside diameter of the tube in mm
203
under what conditions may a chest drain be placed?
chest open or closed
204
what does the site of a chest drain depend on?
unilateral or bilateral condition
if mediasteinum is intact
205
where should the end of a chest drain sit?
cranioventral but not too close to thoracic inlet
206
what must you ensure when measuring length of chest drains before placement?
all fenestrations are sat genuinely within the chest
207
what can happen if chest drain fenestrations are not all within the chest?
iatrogenic PT
incorrect measurement of air drained
208
what part of a chest drain is the most likely location of complications?
connectors
209
what must be ensured about chest drain connectors?
appropriate ones to allow for efficient and safe drainage without risk of iatrogenic PT
210
what does how a chest drain is secured depend on?
drain type
211
how are trochar drains secured?
roman sandal sutures
212
how are seldinger drains secured?
built in anchor flanges to facilitates securing to the body wall with simple sutures
213
how can chest drains be protected from patient interference?
24 hour nursing care
gate clamps
secure sutures
body bandage
buster collar
214
can trochar drains be placed under sedation of GA?
most likely GA
215
what types of stylet often come with trochar drains?
sharp
blunt
216
what can be done during trochar drain placement to prevent air leaks?
subcutaneous tunnel created before entering chest cavity
217
what are the benefits of trochar chest drains?
lots of different sizes
versatile - useful for air or fluid
large bore and so less likely to block
robust and dont collapse
easy to place once technique learned
most are transparent so easy to see if blocked
rigid so easy to place where required
218
what are the negatives of trochar chest drains?
need GA to place
higher complication rate than narrow bore
needs careful training to place
good suture technique required to ensure they stay in place
less comfortable than narrow bore
219
what type of chest drain is more expensive?
seldinger may cost more for actual drain but cheaper overall if no GA needed
220
is a subcutaneous tunnel needed for a seldinger drain?
no as placement technique is less invasive and so air leaks are less likely
221
what are the benefits of seldinger chest drains?
no GA
easy to place
easy to secure
versatile
more comfy
222
what are the downsides of seldinger chest drains?
may not cope with pleural fluid
smaller sizes can be difficult as there may be too much within the chest or outside the chest
not as rigid so can end up with strange placement
may not be able to do SQ tunnel if needed as introducer catheters are not that long
223
what is the issue with to much drain inside the chest?
prone to kinking
224
what is the issue with to much drain outside the chest?
vulnerable to patient interference
225
when is a pleuraport used?
palliative care where long term drainage is needed
226
how are pleuraport drains placed?
surgical placement
227
what needles are used to drain a pleuraport?
huberpoint needles
228
what equipment is needed to place a chest drain in a closed chest?
sterile prep
anaesthetic equipment and monitoring as needed
assistant
chosen chest drain, pre measured
scalpel and blade
suture kit
fenestrated drape
3 way tap
syringes (size dependant on volume to be drained)
extension set
kidney dish
suture
229
how can a chest drain be secured?
built in anchor flanges and simple interrupted sutures
external drain securing sutures (e.g. roman sandal)
230
what is crucial about trochar drain securing?
must be done very carefully as risk of premature removal and pneumothorax is high
231
what are the main ways of draining a chest drain?
intermittent
continuous
232
what is particularly important if chest drain is being used intermittently?
connectors must be secure
233
how often should a chest drain be drained?
vet decision but usually every 4-8 hours
234
what does the frequency of chest drainage depend on?
RR
presence of dyspnoea
235
what are the main continuous chest drainage options?
Hemlich valve
commercial drainage unit that uses continuous suction
236
what cases is continuous chest drainage used for?
large air leak pneumothorax
237
why must care be taken over suction level with continuous thoracic drainage?
can collapse tube and/or aspirate tissue that could be damaged or block the drain
238
how can you reduce the risk of infection for a patient with a chest drain?
aseptic technique at all times
good bandage hygiene
change all soiled bandages
early identification of infection and treatment
culture before treatment with antibiotics
potentially early removal
239
what analgesia may be utilised for a hospitalised patient with a chest drain?
LA around drain site
systemic opioids
LA down drain itself
CRI
paracetamol
240
what analgesia may be utilised for a patient who has been discharged following placement and removal of a chest drain?
NSAID
paracetamol (only in dogs)
241
what is the negative aspect of using opioids in thoracotomy patients?
can affect breathing
242
what are the main complications associated with chest drains?
failure to place
failure to drain
patient interferance
iatrogenic
introduction of infection
243
what are the main issues seen with chest drain placement?
unable to place
incorrect placement
244
what are the main ways a chest drain may be incorrectly placed?
went caudal not cranial
didn't enter thorax
stuck in mediasteinum
245
what should be done following chest drain placement to check position?
xray
246
why may a chest drain fail to drain following placement?
inadvertent or accidental removal
tube disconnection
tube obstruction
tube kinking
tube slipped out from chest a little
247
how may a patient interfere with a chest drain?
removal or chewing either part of or entire drain
248
what iatrogenic problems can there be with chest drains?
haemmorhage / haemothorax
heart or lung damage
inappropriate or premature removal
nerve damage
pneumothorax
pyothorax
seroma
subcutaneous emphysema
249
how can you check to see if pleural fluid from a chest drain is fresh blood and so indicative of haemorrhage?
PCV
see if it clots (only fresh blood will)
250
what nerve may be damaged by chest drain placement?
phrenic
251
how can iatrogenic pneumothorax be prevented in a patient with a chest drain?
check connectors
check fenestration
252
how can iatrogenic pyothorax in a chest drain patient be prevented?
aseptic technique
253
what is seroma often caused by in chest drain patients?
high volume effusion - usually resolves
254
where is subcutaneous emphysema often seen in chest drain patients?
around skin incision
255
what can be used to treat / manage subcutaneous emphysema in chest drain patients?
antibiotic ointment around incision site
256
how can subcutaneous emphysema be prevented in chest drain patients?
care with incision size
check fenestration position
removal of drain leading to resolution
257
who makes the decision about chest drian removal?
vet
258
why may a chest drain remain in place?
ongoing treatment needed via drain
clinically significant production of fluid/air
259
what level of drain fluid production may suggest removal of the drain?
2ml/kg/h or a downward trend towards 25% of original production
260
what are the reasons for chest drain removal?
unacceptable complications where risk of tube staying in is greater than risk of removal
once volume has reduced sufficiently that removal is unlikely to be a risk
swapping to pleuraport for long term palliation
261
when may a chest drain be removed in a patient with pyothorax?
fluid out is of simular volume to fluid going in
documentation of reduction in signs of infection (e.g. bacteria or neutrophils)
262
what type of chest drain is this?
trochar with gate clamp, stylet removed and one way connector
263
what type of chest drain is this?
trochar with stylet and gate clamp
264
what type of chest drain is this?
seldinger
265
what type of chest drain is this?
pleuraport
266
what is involved in stabilising a patient for thoracotomy?
ASA grading and risk assessment
IVFT
drugs
O2
bloods
267
what must be managed about IVFT in thoracotomy patients?
not too much
use BP and PQ to assess
268
what are the analgesic considerations for thoracic surgery?
pre-eptive
multimodal
rescue required in theatre
269
what are the antibiotic considerations for thoracic surgery?
is the patient already on them
is there a plan for intra operative antibiotics
270
what are the surgical considerations for thoracic surgery?
approach
kit needed
specialised instruments
predicted complications and their management
271
what are the 4 main approaches for thoracic surgery?
left thoracotomy
right thoracotomy
sternotomy
thoracoscopy
272
how is the location of thoracotomy described?
numbered rib space incision is made at
273
what are the benefits of thoracotomy?
less painful than sternotomy
274
what must be clarified before a thoracotomy is performed?
condition can be treated with unilateral approach
need to be sure of side to approach
need to be sure of intercostal space to use
275
what does the side the thoracotomy is performed on depend on?
side affected
where the organ is more accesible
276
what structures are best accessed from the left side?
oesophagus
PDA
277
what are the negatives of sternotomy?
more painful
less useful for issues in the dorsal thorax
278
what are the benefits of sternotomy?
good for bilateral conditions
better for exploratory thoracotomy
279
what are the benefits of thorascopy?
least painful
rapid recovery
280
what are the negatives of thorascopy?
steep learning curve
specalised equipment
not often seen
limitations to procedures which can be completed using a scope
281
what position must the patient be in for thoracotomy?
lateral recumbancy with the side to be explored uppermost
282
what part of the chest can be assessed with thoracotomy?
ipsilateral side
283
how is a thoracotomy closed?
sutures
284
what position must the patient be in for sternotomy?
dorsal recumbancy
285
what approach is used for sternotomy?
midline
286
how is the thoracic cavity accessed in sternotomy?
osteotomy with saw
287
what can be assessed during sternotomy?
left and right sides of the chest
288
how is a sternotomy closed?
metal wire or sutures
289
what suture material may be used to close the sternum?
large PDS
290
what clip is needed for a thoracotomy?
correct side of chest
thoracic inlet to mid abdomen
spine and midline
291
what clip is needed for a sternotomy?
thoracic inlet to mid abdomen
below axilla on both sides
292
what clip is needed for a thoracoscopy?
full clip in case need to convert to open
293
how should a patient be positioned for thoracotomy?
lateral
front and back legs loosely tied out of the way
+/- sandbag beneath chest to ensure it is level
294
how should a patient be positioned for sternotomy?
dorsal
legs loosely tied out of the way
sandbags on either side to stabilise if necessary
295
how should a patient be positioned for thoracoscopy?
either lateral or dorsal depending on the procedure
296
what are the main instruments used for thoracic surgery?
longer handled standard instruments
retractors
tissue forceps
sternotomy saw / equipment
297
what standard instruments usually have longer handles for thoracic surgery?
tissue forceps
scissors
needle holders
298
what types of retractors can be used for thoracic surgery?
handheld
self-retaining
299
what sort of tissue forceps should be used in the thorax?
| Give an example
atraumatic e.g. debakeys
300
what is the role of atraumatic tissue forceps in thoracic surgery?
tissue handling
fine dissection
clamping vessels prior to ligation
301
what is the role of sternotomy instruments?
break through bone
302
what are the main handheld retractor used in thoracic surgery?
malleable
langenback
303
name this instrument
langenbeck retractor
304
what are the main self retaining retractors used in thoracic surgery?
finochettio
gelpis
305
name this retractor
finochettio
306
name this retractor
gelpis
307
name this retractor
malleable
308
name this instrument
debakey forceps
309
what is the function of debakeys?
a traumatic tissue forceps
310
what clamps may be used in thoracic surgery?
vascular
satinsky
soft palate
311
what are satinsky clamps used for?
vessels prior to ligation
312
name this instrument
vaascular clamp
313
name this instrument
satinsky clamp
314
name this instrument
right angled clamp
315
name this instrument
soft palate clamp
316
what forms do right angled clamps come in?
ratchet and non-racheted
317
what instruments may be used for a sternotomy?
manual: chisel and hammer
electrical: oscillating saw
318
what additional items will be needed for thoracic surgery?
lap swabs
wire or thick suture
suction
pre-selected chest drain and connectors
tourniquet
pledget sutures
vessel loops
319
what suture will be needed to close the sternum?
1 PDS or 0 PDS
320
what basic electrosurgery equipment is available?
monopolar
bipolar
321
what is required alongside monopolar?
earth pad under patient to complete the circuit and prevent burns
322
what advanced electro surgery equipment is available?
Gen11
ligasure
harmonic
323
what may advanced electrosurgical tools be used instead of?
stapler
324
what is a partial lung lobectomy?
part of a lobe removed
325
what is a total lung lobectomy?
full lobe removed
326
what is a pneumonectomy?
one half of the lung is removed
327
how may lung be removed?
sutures
staples
328
what is the advantages of suture for lung lobectomy?
useful if stapler fails
less expensive
329
what is the disadvantages of suture for lung lobectomy?
slow
technically challenging
higher risk of leakage
330
what is the advantages of staples for lung lobectomy?
quick
lower risk of leakage
331
what is the disadvantages of staples for lung lobectomy?
more expensive
initially scary to do!
332
what must always be performed after lung lobectomy?
leak test
333
what is a leak test following lung lobectomy checking for?
ensuring that staples have closed bronchus and that there is no risk of pneumothorax
334
what would indicate a failed leak test?
bubble following IPPV demostrating lung leak
335
how is a leak test performed?
fill chest with warm saline
IPPV performed
check for air bubbles to ensure no leak
suction fluid out once happy
336
where should the chest be filled with saline to?
above the level of the lungs
337
Poster about managing resp system
Look at LP/TC/aspergillosis/FB/BOAS
you fool
