Thoracic – TCAR trauma care exam study guide verified 100%

Thoracic – TCAR trauma care exam study guide verified 100% Blood supply upper 2/3 of trachea - correct answers-inferior thyroid arteries Blood supply lower 2/3 of trachea - correct answers-bronchial arteries Blood supply lung parenchyma - correct answers-bronchial arteries Pathway of azygous vein in the thorax - correct answers-runs along R side and dumps into superior vena cava Pathway of thoracic duct in the chest - correct answers-runs along R side, crosses midline at T4-T5, goes into L neck and dumps into L subclavian vein at junction with LIJ Pathway of phrenic nerve in thorax - correct answers-runs anterior to hilum Pathway of vagus nerve in thorax - correct answers-runs posterior to hilum What fissures exist in the lungs? - correct answers-Major oblique separates RLL from middle and upper lobe Minor separates upper from middle lobe Muscle used in quiet respiration - correct answers-Diaphragm 80%, intercostals 20% Accessory muscles of respiration - correct answers-SCM Levators Serratus posterior Scalenes Main surface active agent in surfactant - correct answers-phosphatidylcholine Alveolar, arterial, and venous pressures in lung zones in upright person - correct answers-Zone I: PA > Pa > Pv Zone II: Pa > PA > Pv Zone III: Pa > Pv > PA Normal pulmonary artery pressure - correct answers-25/10 (mean 15) What predicted value is needed for pulmonary resection? - correct answers-Predicted postop FEV1 > 0.8L (>40% predicted) What can be done if the predicted postop FEV1 is close to 0.8 (40% predicted)? - correct answers-Obtain a V/Q scan and see how much that segment actually contributes Single best predictor of being able to wean off ventilator after pulmonary resection - correct answers-FEV1 Minimum DLCO for lung resection - correct answers->11-12 ml/min/mmHg CO (>50% predicted value) What six things effect DLCO? - correct answers-Pulmonary capillary surface area Hgb Alveolar architecture Dead space Low CO Pulmonary HTN What pCO2 is necessary for lung resection? - correct answers-<45 at rest What pO2 is necessary for lung resection? - correct answers->60 at rest, not on O2 What VO2max is needed for lung resection? - correct answers->10 ml/kg/min (maximum o2 consumption) Overall PFTs required for pulmonary resection - correct answers-FEV1 >0.8L (>40% predicted) DLCO >11-12 ml/min/mmHg CO (>50% predicted, or 40% postop) pCO2 <45 at rest pO2 >60 at rest, not on O2 VO2 >10 ml/kg/min MCC of hypoxemia after pulmonary resection - correct answers-V/Q mismatch from atelectasis (shunt) MCC of hypercarbia after pulmonary resection - correct answers-alveolar hypoventilation (poor minute ventilation RR x TV) MC nerve injury after pulmonary resection - correct answers-brachial plexus injuries How can common peroneal nerve injuries be avoided durin pulmonary resection? - correct answers-flex dependent leg Most common resection resulting in persistent air leak - correct answers-segmentectomy/wedge MC resection resulting in atelectasis - correct answers-lobectomy MC resection resulting in arrhythmias - correct answers-pneumonectomy (R MC) MC resection resulting in postop TEF - correct answers-pneumonectomy (R MC) MC resection resulting in postop bronchopleural fistula - correct answers-pneumonectomy (R MC) MC resection resulting in mortality - correct answers-pneumonectomy (R MC) What is post-pneumonectomy syndrome? - correct answers-MC after R pneumonectomy mediastinal shift causing main bronchial compression How is post-pneumonectomy syndrome treated? - correct answers-Silicone issue expanders on pneumonectomy side to shift mediastinum back What should be expected with hypotension, cyanosis, tachycardia, and displaced heart on CXR after R pneumnoectomy? - correct answers-Cardiac herniation through pericardium Treatment and prevention of cardiac herniation after R pneumonectomy - correct answers-Pericarial Gortex patch What should be expected with pooled secretions, recurrent infection, or bronchial stump blowout after L pneumonectomy? - correct answers-Long bronchial stump syndrome How is long bronchial stump syndrome treated? - correct answers-Shorten bronchus and cover with flap Mortality with wedge? lobectomy? pneumonectomy? - correct answers-wedge - 1% lobectomy - 3% pneumonectomy - 6% (R>L) Treatment of persistent air leak in CT - correct answers-Check system 2nd CT anteriorly Bronch (foreign body, BPF, mucous plug) CT chest Wait 7 days then mechanical pleurodesis Treatment of atelectasis resistant to usual measures - correct answers-Bronch to look for mucous plugging Increase TV if already vented MCC of adult TEF - correct answers-Esophageal cancer eroding into trachea Treatment of adult TEF caused by esophageal cancer erosion - correct answers-Stent esophagus Treatment of postop adult TEF - correct answers-Repair esophagus primarily Close hole in trachea or bronchus Interpose tissue so TEF won't come back (pericardial fat pad or intercostal muscle) Primary cause of ARDS picture after pneumonectomy - correct answers-Inflammatory reaction (PMNs, O2 radicals, cytokines, vascular permeability) Increased perfusion to remaining lung Tx like ARDS MCC of empyema - correct answers-pneumonia with subsequent infection of parapneumonic effusion Symptoms of emypema - correct answers-pleuritic chest pain, fever, cough, SOB Pleural fluid in empyema - correct answers-WBC > 500 cells/cc Bacteria + gram stain 3 stages of empyema - correct answers-Exudative Fibrinopurulent Organizing Treatment of stage I - exudative empyema - correct answers-CT + abx Send cx for drainage and cytology Treatment of stage II - fibrinopurulent empyema - correct answers-CT + abx send drainage from cultures and cytology failure to re-expand lung - VATS deloculation Treatment of stage III - organizing (chronic) empyema - correct answers-Decortication +/- muscle flap send fluid for cultures and cytology abx nutrition Eloesser flap if can't tolerate decort allowing direct opening to external environment for drainage MCC of early bronchopleural fistula - correct answers-technical error Treatment of early <7 days bronchopleural fistula - correct answers-reoperation with intercostal muscle flap over bronchus Presentation of early bronchopleural fistula - correct answers-massive air leak with respiratory compromise collapsed lung and ptx on xray MCC of late postop or non-surgical bronchopleural fistula - correct answers-pressure from empyema makes hole in bronchus How do late postop or non surgical bronchopleural fistulas present? - correct answers-abrupt serosanguinous or purulent sputum production +/- respiratory distress What is the key preventative measure for a late postop or nonsurgical bronchopleural fistula? - correct answers-protect the contralateral lung from aspiration of empyema fluid What will be seen on CXR for a late postop or non-surgical bronchopleural fistula? - correct answers-After lobectomy or nonsurgical - fluid collection and PTX, thick rind if empyema present After pneumonectomy - lowering of air fluid level on pneumonectomy sie with new infiltrate on contralateral side Treatment of late postop or nonsurgical bronchopleural fistula - correct answers-Chest tubes Affected side down Bronch to confirm dx Broad spectrum abx After lobectomy - reexpand lung if organized empyema then decort or eloesser flap After pneumonectomy - Claggett procedure fill post pneumonectomy space with permanent abx solution + bronchus coverage with intercostal muscle flap Possibly high frequency ventilation Claggett procedure - correct answers-for bronchopleural fistula after pneumonectomy - fill post p