Personal CV > Thoracic Procedures > Flashcards

Thoracic Procedures Flashcards

(44 cards)

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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?

Study These Flashcards
A

-Aminophylline

19
Q

How do phosphodisterase inhibitors work?

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A

-inhibit breakdown of cAMP

20
Q

How do steroids work and name one.

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A
  • Reduce mucosal edema and suppress inflammation

- Beclomethasone

21
Q

How does cromolyn sodium work?

Study These Flashcards
A

-Mast cell stabilizer which prevents histamine release

22
Q

When would you use digitalis?

Study These Flashcards
A
  • Left sided heart failure

- SVT or rapid ventricular response

23
Q

When would prone position be used?

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

What is the standard thoracotomy position?

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A

Lateral decubitis

25
How is ventilation and perfusion effected in the lateral decubitus position? And which happens first?
- Dependent lung is better perfused (first) | - Independent lung is better ventilated
26
What are the advantages of lateral decubitis?
- Complete access hemithorax - Length of incision can be increased - Patient easily tilted - Safest for hilar - Control of hilar vessels
27
Disadvantages of lateral decubitis
- Opposite hemithorax inaccessible - V/Q mismatch - Contamination of dependent lung - Decreased FRC, airway closure, and atelectasis of dependent lung
28
How can you separate the lungs?
- Double lumen tube - Univent ETT - Bronchial blocker
29
3 reasons to separate the lungs?
- Prevent cross lung contamination - Redistribute ventilation - Unilateral bronchopulmonary levage
30
Indications to separate the lungs?
- Exposure for: - -Thoracic aortic aneurysm - -Lobectomy - -Pneumonectomy - -Esophageal resection - -Subsegmental resection
31
Increased risk of death during thoracotomy?
- Cardiopulmonary disease - Obesity - Advanced age - Tumor - Pericardial involvement - Pulmonary HTN
32
What should be avoided in GA and one lung ventilation?
- N2O | - Hypoxia
33
Steps when hypoxia on one lung ventilation?
- 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
Contraindications to DLT?
- Lesions along tube pathway - Difficulty obtaining direct vision intubation - Critically ill patient can't tolerate apnea - Full stomach
35
Things to worry about with bronchoscopy?
- Sharing airway w/ surgeon - Arrhythmias - Hypertension - Hypoxemia
36
Rigid bronchoscopy tidbits.
- Glyco early to dry up secretions - Topical - Short acting drugs - Light sedation
37
When is a fiberoptic bronch used?
-Eval of tracheobronchial tree deeper than rigid
38
Contraindications to bronchoscopy?
- Unstable CV - Life threatening arrhythmias - hypoxemia
39
Problems encountered during bronchoscopy?
- Coughing - HTN - Tachycardia - Bleeding my require lung seperation
40
Indications for pneumonectomy
- Non-small cell lung CA - Drug resistant TB - Trauma - Myobacterium - Fungal infection - Necrosis
41
What is eaton lambert syndrome?
- Muscle wasting | - May influence muscle relaxant choice
42
Chest tubes are clamped to prevent what?
-Mediastinal shifts
43
Ipsilateral mediastinal shift problems?
- Hypotension - arrhythmias - cardiac herniation - Pulmonary edema
44
Contralateral mediastinal shift signs?
- Decreased lung function | - decreased venous return
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