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Thoracic surgeries
- 2. CHEST TRAUMA Sharp injuries Blunt injuries Medical procedures Falls
- 4. Causes Blunt or penetrating trauma to the chest Myocardial rupture Cancer Pericarditis Cardiac surgical procedures / iatrogeni trauma Anti coagulant therapy Post op bleeding
- 5. Pathomechanism Fluid can be blood or pus Outer surface of pericardium is comparatively not pliable Excess pressure on heart Less blood entering the ventricles Decreased cardiac output
- 6. Classical signs Low blood pressure Decreased stroke volume Jugular venous distension Muffled heart sounds ST segment changes on ECG
- 7. Symptoms Chest pain Weak / fainting Breathing difficulty Tachypnoea
- 8. Investigations Echocardiography X ray – large globular heart
- 9. Treatment Oxygen therapy Emergency thoracotomy Pericardiocentecis – 5th ICS (3-5 cm lateral to sternum) / subxiphooid approach Regular checking for chest tube blockages post surgery
- 10. Complications Shock Arrhythmias Embolism
- 11. Rib fractures Chest binders for simple fractures For multiple fractures………..
- 12. Flail chest A segment of the thoracic cage is separated from the rest of the chest wall At least two fractures per rib (producing a free segment)
- 14. Cause lung contusion Require mechanical ventilation
- 15. Diagnosis Bruises on the chest wall Crepitus on palpation Paradoxical movement of the chest wall in the injured area Can be appreciated also on palpation Chest x ray
- 16. Complications Lung contusions, pneumonia Hemo thorax pneumothorax
- 17. Investigations X ray CT scan
- 18. Management Proper oxygenation and ventilation 100% oxygen Mechanical ventilation and intubation for contusions Analgesia NSAIDS Patient controlled administration of opioid infusion Continuous epidural infusion , local anaesthesia – does not impede breathing movements
- 19. Prophylactic ICD insertion along with mechanical ventilation External fixation and stabilization
- 20. Positive pressure ventilation for internal stabilization Complete cardio pulmonary monitoring
- 21. Rib resection Surgical removal of the rib
- 22. If can cause lung contusion Cancer For bone graft For thoracic outlet syndrome
- 23. Decortication Removing restrictive layer of fibrous tissue over the lung For re-expansion of the lung tissue Pleural space disorders Fibro thorax – btw lung and visceral pleura Tuberculous empyema hemothorax
- 24. A stab to the right chest presented 1 week later with fever, chills, and dyspnea. The radiograph shows an inflammatory process that did not drain via a needle
- 25. Indications Initial drug therapy Decortication if long term drug therapy fails
- 26. Contraindications It is of no use for diseased lung which has lost it’s pliability Pleural space infections Uncontrolled lung infections Patient’s nutrition status Sepsis Further Rx would be pleuropneumoperitoneum
- 27. VATS(video assisted thoracoscopic surgery) Similar to laproscopic surgery Reduced mortality with this procedure Extreme care has to be taken Anatomical considerations – heart, abdomen, subclavian vessels, pulmonary artery, air leaks causing pneumo peritoneum, phrenic nerve, trachea, eosophagus, sympathetic chain posteriorly
- 28. TUBERCULOSIS Caused by mycobacterium tuberculosis Weak immune system
- 29. Spreading of disease Primary Secondary Miliary
- 30. Symptoms Severe cough 3 weeeks or more Chest paim Coughing blood or sputum Weakness or fatigue Weight loss Loss of appetite Chills Fever Night sweats
- 31. Investigations X ray Montoux test Sputum examination Blood tests
- 32. Thoracocentesis/ Pleural tapping In pleural diorders – hemo / pyo / hydro / pneumo/ chlyo (lymph) thorax. For diagnosis and treatment Seen in most of the chest infections in severe stages Needle into the thorax – into the pleural cavity
- 35. Causes Hemorrhage Infection inflammation Malignancy Iatrogenic Connective tissue disorders Nephrotic syndrome
- 36. Thoracotomy Incision into the thoracic cavity for diagnostic procedures or for surgeries For lung surgeries or heart surgeries Or for the structure of the thoracic cavity … anterior spine, lower eosophagus
- 38. Thoracic surgeries – lobectomy, pneumonectomy, segmentectomy, ICD insertion, pleural cavity disorders wedge resection etc… Incisions used – median sternotomy, posterolateral thoracotomy, anterolateral, clampshell (bilateral anterolateral)
- 40. Complications – infection, resp failure, pneumothorax, subcutaneous emphysema Post operative treatment – medical, PT
- 41. Wedge resection
- 42. Lung cancer Fibrosed lung Infection ILD Blebs Bronchiectasis Pleural adhesions Pleurodesis
- 43. Investigations CT scan X rays
- 44. Pnemonectomy