Unit 3 Week 9 Thoracic Procedures

Question 1

what is the most common approach to most cardiac procedures?

Answer 1

median sternotomy

Question 2

what is a posterolateral thoracotomy approach used for?

Answer 2

lung resections
hemo, pleuro, or pneumo thorax surgeries

Question 3

what muscles are effected with a posterolateral thoracotomy approach?

Answer 3

lower trap, serratus anterior, and latissimus dorsi

Question 4

what is an anterolateral thoracotomy approach used for?

Answer 4

Some cardiac sx and anterior lung, access to hilum and esophagus

Question 5

what muscles are effected with a anterolateral thoracotomy approach?

Answer 5

pectoralis muscles and serratus

Question 6

what is an axillary (lateral) thoracotomy approach used for?

Answer 6

minimally invasive cardiac procedures and epicardial pacemaker placements

Question 7

what are the advantages/disadvantages with a axillary (lateral) thoracotomy approach?

Answer 7

advantages: minimizes change in pulmonary function and mobility; greatly aids recovery; shorter length incision to be muscle-sparing for chest and shoulders
disadvantages: least amount of visibility for surgeon

Question 8

what is a subxiphoid incision used for? what is the advantage?

Answer 8

pericardium or epicardium procedures
small incision

Question 9

what is a thoracoabdominal incision used for? what is affected?

Answer 9

diaphragmatic procedures
ribs and abdominals

Question 10

what is a minithoracotomy?

Answer 10

shorter incisions used in surgical techniques

Question 11

what are the advantages of VATS and RATS vs. an open thoracotomy?

Answer 11

-greater delicate handling and precision of instrumentation for surgeons
-reduced LOS
-decreased blood loss
-lower incisional pain
-less negatively affected pulmonary functions (lung volumes)
-earlier pt mobility
-decreased inflammatory cytokine reaction to surgery

Question 12

what are the common complications with thoracic surgery?

Answer 12

-most often related to pain, blood loss/bleeding, medication effects, and infection

Question 13

what are the major causes of perioperative morbidity and mortality with thoracic surgeries?

Answer 13

-respiratory complications: atelectasis (lung collapse), pneumothorax (air in lungs), pneumonia (lung infection), and respiratory failure
-prolonged air leaks
-cardiac complications: arrhythmias and ischemia

Question 14

what muscles are commonly involved with chest surgeries?

Answer 14

latissimus dorsi, serratus, pectoralis major, trap, rhomboid, teres major

Question 15

what is the purpose of physical therapy after a cardiothoracic surgery? what early therapeutic interventions are used?

Answer 15

reduce complications
Splinted cough, incentive spirometry, functional mobility to encourage chest expansion and airway clearance, reducing the risk of atelectasis, pneumonia, and venous thomboembolisms

Question 16

what are the purposes of a chest tube?

Answer 16

remove air, fluids, or blood from pleural space
prevent air or fluid from reentering pleural space
reestablish intrapleural and intrapulmonary pressures after surgery or trauma

Question 17

where is a chest tube usually places?

Answer 17

into mediastinum to drain fluid from pericardial sac
upper lung for air
lower lung for fluid

Question 18

how does a chest tube and its collection system work?

Answer 18

at first the device is attached to wall suction as the amount/size reduced suction is eliminated and progressed to gravity only
the collection system should remain below to insertion and should not be tipped over

Question 19

what are pacemakers used for?

Answer 19

to help correct and maintain normal cardiac rate and rhythm by emitting low energy electrical impulses via leads placed in the heart

Question 20

what are cardiac defibrillators used for? and how does it differ from a pacemaker?

Answer 20

to manage uncontrolled life threatening ventricular arrhythmias by defibrillating the myocardium as needed
it is leadless and implanted into the heart

Question 21

what is an IABP?

Answer 21

intra-aortic balloon pump: assists with circulation of blood and reduced oxygen consumption
balloon is inflated at diastole (rest) and pushes the blood into the ventricle preloading it. when the heart contracts the balloon is deflated. this increased the cardiac output and ejection fraction

Question 22

what is PVAD? how does it differ from an IABP?

Answer 22

percutaneous ventricular assist device: unloads the failing ventricle to improve systemic perfusion to other organs
it is an external device

Question 23

what arteries/veins are most commonly used for ECMO?

Answer 23

femoral artery and vein (limits mobility)

Question 24

what is ECMO?

Answer 24

extracorporeal membranous oxygenation
takes blood out of the femoral artery, brings it into the pump, and pumps it through an oxygenator and then back through the femoral vein

Question 25

what are the two types of dialysis?

Answer 25

peritoneal: fluid and chemicals are put into the abdomen to help filter the blood
traditional hemodialysis: takes blood out, processes it, and then puts it back in

Question 26

what is the purpose of dialysis?

Answer 26

filters the fluid and electrolytes and corrects the imbalances that are caused by kidney failure