Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
180 Cards in this Set
- Front
- Back
What are the obstructive lung disorders?
|
-asthma
-emphysema -chronic bronchitis -cystic fibrosis -bronciectasis -bronchiolitis |
|
Asthma is characterized by variable _____ _____ airflow obstruction and airway/bronchial ______________.
|
reversible expiratory
hyper-responsivenss |
|
Asthma is generally allergen-induced immunologic responses by _____________.
|
several chemical mediators
|
|
Flow volume loops for obstructive disease are affected on ______. FEV1 is less than of equal to _____% of predicted.
|
expiratory
60 |
|
The degree of reversilbility, increased airway hyper-reactivity and after admin of bronchodilators you will see a 12% or greater increase in FEV1 and 200 ml increase in Peak expiratory flow rate are the things that make...?
|
asthma different from chronic bronchitis
|
|
Preop Assessment for Asthma...
|
-what is your breathing baseline and how is your breathing now?
-current clinical symptoms, last exacerbation, infections? -medication regimen -comparison and review of PFTs -exercise tolerance? -sputum at baseline and what is it currently? -last time presented to ED and last time received systemic steroids? -benefit to stop smoking 8 wks preop -thorough chest auscultation |
|
smoking cessation is beneficial to surgical pts greater than ____ weeks preop but not any sooner.
|
8 weeks
|
|
Preop laboratory studies for asthma?
|
-CXR: for baseline, signs of infections, severity of dx
-FEV1 or PEFR to assess severity of dx -Full PFTs -Baseline ABG -Perhaps EKG to assess right heart failure |
|
an additional dose of ____ and _____ ____ may be given just before induction (inhalers and systemic corticosteroids)
|
ipratropium and beta agonist
|
|
You should avoid giving an ___ ______ before anesthesia for the risk of bronchospasm. Consider using non pariculate antacid such as bictra or reglan.
|
H2 blocker
|
|
Asthma can be managed preop by Leukotriene inhibitors like ______, beta adrenergic agonists like _____-_____ or anticholinergic drugs like ______-____
|
singulair
salmetrol-serevent tiotropium-spiriva |
|
_____ is classified as a histamine blockers.
|
chromolyn
|
|
Chromolyn works by suppressing the secretory response of ___ ____ reaction
|
IgE-Antigen
|
|
Chromolyn is effective only in _____ ___ not basophils.
|
mast cells
|
|
How is chromolyn deliverd?
|
only by inhalation
|
|
Chromolyn can only be used ______ and is ineffective following histamine release.
|
prophylactically
|
|
Examples of inhaled corticosteriods are?
|
Beclomethason (QVAR)
Tramicinolone (Azmacort) Fluticasone (Flovent) |
|
The PO corticosteroid most given is _____. It can cause hypothalmic pituitary adrenal suppression so if the pt has received it in the last ____ months give Solucortef 100mg preop.
|
prenisone
6 |
|
Corticosteriods have __________ effects on the bronchial mucosa. Stabilize ____ cell membranes. Decrease airway ________. Controls chronic symptoms and prevents ______.
|
-anti-inflammatory
-mast cell -hyper-responsiveness -exacerbations |
|
Cysteinyl-lekotriene (CysLT1) antagonist is a?
|
leukotriene inhibitor
|
|
Cysteinyl-lekotriene (CysLT1) competitively blocks ______ __ from binding to the receptor. Examples of this are Zafirlukast, montelukast and pranlukast.
|
leukotriene D4
|
|
Leukotriene inhibitors also inhibit the conversion of ______ acid to leukotriene A inhibiting the generation of leukotrienes. An example is Zileuton.
|
arachidonic acid
|
|
____ is a good induction choice for asthmatics because it bronchiodilates but a downfall is that it also increases secretions.
|
ketamine
|
|
both ____ and ____ are good choices for induction in an asthmatic because they bronchodilate and don't release histamine.
|
etomidate and propofol
|
|
the ____ form of propofol dose contain sulfites so this should be avoided in an asthmatic.
|
generic
|
|
the neuromuscular relaxants that release histamine and should be avoided in an asthmatic are?
|
succinylcholine and atricurium-dose and speed dependent
(curare, mivacurium) |
|
Regarding pain management in an asthmatic; ____ should be avoided due to histamine release but fentanyl and analogues are okay to use.
|
morphine
|
|
avoid ____ and ____ in asthmatic related to prosteglandin decrease.
|
ketorolac and NSAIDs
|
|
All volatile anesthetics are potent _____ but _____ and ____ may irritate the airway.
|
bronchodilators
iso and des |
|
reversing neuromuscular blocking agents is not a problem in the asthmatic because _____ are always given with the reversal which is an anticholinesterase.
|
anticholinergic
|
|
the most critical time intraop is?
|
airway instrumentation
|
|
Although regional anesthesia may decrease the risk of airway induced bronchospasm, a high spinal may aggravate ______ by blocking sympathetic tone (T1-T4)
|
bronchoconstriction
|
|
What are the goals of induction in the asthmatic patient?
|
-achieve deep anesthesia before airway manipulation and surgical stimulation
-avoid histamine releasing drugs -avoid bronchospasm |
|
Again, the agents to avoid in an asthmatic are?
|
-morphine
-atracurium -mivacurium -meperidine -succinylcholine (sometimes ok to use) |
|
administering ipratropium and a beta 2 agonist just before ____ help to reduce bronchospasms.
|
induction
|
|
1-1.5mg/kg IV of ______ can also help to reduce bronchospasm.
|
lidocaine
|
|
Some things to think about for differential diagnosis for wheezing...
|
-foreign body
-partially blocked/kinked ETT -light anesthesia -aspiration -endobronchial intubation -tension pneumo -pulm embolism -pulm edema -acute exacerbation of asthma -anaphylaxis |
|
What is the first step of management for an OR emergency related to asthma?
|
deepen your anesthetic agent and 100% FiO2
|
|
What is the second step of management for an OR emergency related to asthma?
|
-auscultate the chest
-verify the problem is bronchospasm -check patency and position of ETT |
|
What is the third step of management for an OR emergency related to asthma?
|
-admin medications
-b-adrenergic agnosits -iv hydrocortison (1.5-2mg/kg -epi (0.1mcg/kg bolus) -aminophylline |
|
for emergence of an asthmatic giving 1.5-2mg/kg of ____ may help to blunt airway reflexes
|
lidocaine
|
|
_______ is the most common pulmonary disorder and it effects more men then women.
|
COPD
|
|
COPD is the loss of elastic recoil of the lung due to destruction of the lung ____. This leads to the collapse or airways during ____, leading in turn to an increase in airway ____.
|
parenchyma
expiration resistance |
|
the obstruction of airway outflow can lead to the enlargement of _____ distal to terminal bronchioles.
|
air spaces (bullae)
|
|
Preop treatment for COPD includes
|
-supportive
-smoking cessation -bronchodilators and glucocorticoids -ipratropium (more effective than B2 agonists in COPD) -treat hypoxemia carefully |
|
Giving oxygen to patients with COPD presents a problem because it can raise ___ in patients who already have CO2 retention.
|
PaCO2
|
|
Giving oxygen to patients with COPD presents a problem because elevating ____ can lead to respiratory failure and it can abolish ______.
|
PaO2
hypoxic pulmonary vasoconstriction (HPV) |
|
What is the preop managements for COPD
|
-thorough pulmonary eval
-cardiac eval -cessation of smoking -abx if warranted -review of lung expansion procedures (spirometry) |
|
what is the intraop management for COPD?
|
-use of minimally invasive surgery
-consider regional anesthesia -avoid long acting neuromuscular blocking agents -alines, central lines? -use of PEEP -humidified O2 -N2O? |
|
_____ ____ follows prolonged exposure to environmental irritants with a hyper-secretion of mucus and inflammatory changes in the bronchi. There is also a productive cough.
|
chronic bronchitis
|
|
the preop eval for COPD includes?
|
-assessment of current symptoms (dyspnea, cought, sputum)
-hx of respiratory infection and exercise tolerance -thorough chest auscultation -consider PFTs, ABG, CXR, EKG |
|
Preoperatively if the COPD pt exhibits signs of respiratory infection give them ____ and possibly _____ if there is a reversible component present.
|
antibiotics, bronchodilators
|
|
Regional anesthesia may offer benefits for surgery of the extremities and lower abdomen because it is ____ or below.
|
T10
|
|
You must use ____ cautiously because you want to treat post op pain but avoid respiratory depression.
|
opiods
|
|
The advantages to N2O are that it decreases the dose of ____ ____ and it goes quick on and quick off.
|
volatile anesthetics
|
|
one disadvantage of N2) is that it can diffuse into ______ quicker than nitrogen can exit, potentially leading to bullae rupture and tension pneumo.
|
airspaces
|
|
another disadvantage of N2) is that concentrations between ___ and ___ % can limit the concentration of oxygen that can be administered while maintaining the appropriate level of anesthesia.
|
50-70%
|
|
_____ _____ occurs due to air trapping. Also called dynamic hyperinflation. Because air cannot be exhaled, pressure builds up in the lung leading to _______.
|
-intrinsic PEEP
-positive end expiratory pressure (PEEP) |
|
in COPD there is increased ____ ___ due to airway obstruction. Meaning, all inspire4d air does participate in gas exchange and exhaled gas may not contain a normal amount of ____ measured by capnography.
|
dead space
CO2 |
|
Restrictive lung disease characteristics are?
|
-decreased vital capacity
-expiratory flow rates remain normal -FEV1 and FVC will be reduced -FEV1/FVC is preserved at >0.7 |
|
What are the types of intrinsic restrictive pulmonary diseases?
|
-pulm edema
-ARDS -Pneumonitis -idiopathic fibrosis (may also see an increased AaO2 gradient) |
|
What are the types of extrinsic restrictive pulmonary diseases?
|
-pleural effusion
-obesity -kyphoscolisosis -ascites -pregnancy |
|
Restrictive pulmonary disease have a decreased lung compliance due to an increase in _________.
|
extravascular lung fluid
|
|
In Restrictive pulmonary disease there should be no ____ surgery. If emergency surgery is needed, oxygenation and ventilation should be optimized
|
elective
|
|
In Restrictive pulmonary disease use _____ support as needed.
|
pressor
|
|
Sarcoidosis causes small lumps which generally heal but if they do not the tissue can remain inflamed and become _____. This can develop into pulmonary fibrosis which distorts the structures of the lungs and can interfere with _____.
|
scarred
breathing |
|
Also, _____ can occur from sarcoidosis. This is where pockets form in the air tubes of the lungs and become sites for infections.
|
bronchiectasis
|
|
On the flow-volume loop for Restrictive pulmonary disease both ____ and ____ are affected.
|
inspiration and expiration
|
|
People with Restrictive pulmonary disease suffer from increased work of breathing because increased effort is needed to move air in and out of the lungs---less air (_____) is moved per decrease in intrapleural ____.
|
volume
pressure |
|
Increased PaCO2 in patients with Restrictive pulmonary disease represents _____ disease. Early on these pts may be hypocarbic however late in the disease the patient will live with a higher PaCO2 in return for not working as hard to breathe.
|
advanced
-hypercarbia and arterial hypoexemia cause vasocontrictive pul htn and cor pulmonale |
|
Regional anesthesia on patients with Restrictive pulmonary disease is similar to regional in other lung disease (safe below T10 as to not impair breathing) however, ____ may be difficult.
|
positioning
|
|
for patients with Restrictive pulmonary disease undergoing GA, _____ and increased ____ may be required.
|
PEEP and Oxygen
|
|
In pts with Restrictive pulmonary disease you can predict post op problems if FVC is less than ____ ml/kg and a preop PaCO2 higher than ___.
|
15
50 |
|
Restrictive pulmonary disease pts by definition have decreased _______. And surgery especially of the abdomen or throax decrease these further. This may make it difficult to clear ______.
|
preop lung volumes
secretions |
|
It is important that asthma is considered _____ whereas COPD is not.
|
reversible
|
|
if you are giving a neb through an ETT you are losing half of the dose so ___ the dose.
|
double
|
|
Wet airways trigger _____ so make sure to have a dry airway.
|
laryngospasm
|
|
For a COPD patient, dont have insp pressures greater than _____ on pressure mode.
|
30
|
|
To help patients with COPD you can _____ the I:E ratio.
|
increase
go from 1:2 to 1:3 |
|
Know the COPD pts _____ baseline and make sure they are at it when waking up=drive to breathe.
|
CO2
|
|
The ___ position offers optimal access of the lungs, pleura, esophagus, great vessels, vertebrae and other mediastinal structures. It alters normal ____ ____ making the pt at risk for hypoxia. The ____ lung is less compliant.
|
-lateral
-V/Q relationship -lower |
|
____ effectively redirects blood flow away from hypoxic or poorly ventilated lung units by the vascular endothelium releasing potent vasocontrcitor peptides called endothelin.
|
HPV
|
|
______ >1 MAC and ____ block HPV.
|
Volatile anesthetics and N2O
|
|
when one side of the chest is opened the negative pressure is ___ and elastic recoil of the lung on that side tends to ______. This can cause progressive hypoxemia and hypercapnia. Effects are overcome by _________.
|
lost
collapse it positive pressure ventilation |
|
Mixing of _____ blood from the collapsed upper lung with oxygenated blood from the ventilated dependent lung widens the alveolar to arterial O2 gradient and often results in ______. Fortunately, blood flow to the non ventilated lung is decreased by ___.
|
hypoxemia
HPV |
|
____ to _____ is poorly matched in mechanically vented pts.
|
ventilation to perfusion
|
|
______ pushes gas into apexes of lung which follows the path of least resistance.
|
positive pressure ventilation
|
|
blood perfuses primarily the ____ parts of lung due in part to the pull of gravity.
|
dependent
|
|
The result of PPV in pts in gas flow to the ____ and blood flow to the ____ resulting in ______ ____.
|
apex
bases VQ mismatch |
|
Poorly ventilated alveoli are prone to _____ and ____.
|
atelectasis and collapse
|
|
What are the indications for one lung ventilation (OLV)
|
-lung resection
-drainage of abscess, cyst or empyema -bronchopleural fistula -bronchial tumors -lung transplant -persistent intrapulmonary bleeding (PA rupture) -esophageal surgery -anterior approach to the thoracic spine -select open heart procedures -improve pt outcomes |
|
OLV can improve pt outcomes by restricting _____ or ____ to one lung.
|
infection or bleeding
|
|
OLV can differentially ventilate each lung after trauma, post op or with a ______ fistula.
|
bronchopleural
|
|
Which mainstem bronchus is longer, the left or right?
|
left
|
|
the right upper lobe orifice is ____ cm from the carina and is higher than the left upper lobe orifice at ___ cm.
|
2.5cm
5cm |
|
the adult trachea is ___-___ cm long
|
11-13
|
|
The trachea begins at the cricoid which is?
|
C4-C6
|
|
The trachea bifurcates at the carina which is?
|
T4-T6
|
|
The right mainstem diverges away at a ___ degree angle. The left mainstem diverges away at a ___ degree angle.
|
25
45 |
|
The following methods are used in OLV.
|
-double lumen ETT
-single lumen ETT with a built in bronchial blocker -single lumen ETT with an isolated bronchial blocker (wire guided) -endobronchial intubation of a single lumen ETT |
|
The disadvantages of single lumen endobronchial tube are?
|
-inability to ventilate or suction other lung
-if placed in right lung, cannot ventilate right upper lobe |
|
the bronchial blocker is placed under ____ guidance. They are beneficial to patients already ______/_____.
|
fiberoptic
intubated/trached |
|
The appropriate size double lumen tube for females is ___-___ fr. for males it is ___-___fr.
|
35-37 (usually 37)
37-39 (usually 39) |
|
in the awake and upright position, you have perfusion to the ____ and lower ventilation from negative pressure generated from spontaneous breaths.
|
bases
|
|
in the asleep and upright position you have perfusion to the ____ (gravity dependent) and ventilation to the ____ because of PPV=V/Q mismatch
|
bases
upper |
|
In the asleep and lateral position, you have perfusion to the dependent side and ventilation to the ___ lobes from PPV. This is a worsened V/Q mismatch because paralysis, bean bags, open chest
|
upper
|
|
complications of double lumen tubes
|
-HYPOXIA
-traumatic laryngitis -tracheal-bronchial rupture -ETT suturing/stapling in the bronchus -decreased venous return |
|
Complications of a throacotomy
|
-volume overload
-broncial disruption -pneumonia/atelectasis -pulm htn -Low CO (r heart failure, decreased preload) -bleeding -dysrythmias |
|
-Managing OLV, you should avoid ____.
-To protect HPV, use ____ and narcotics (avoid IAs) -Use muscle relaxants and atropine |
-N2O
-TIVA |
|
During OLV, restrict ____ because lungs are a venous reservoir.
|
fluids
|
|
During OLV you should have an ____ to monitor for decreased venous return and monitor ABG.
|
Aline
|
|
When ventilation a OLV make sure you are using ____% FiO2. Maintain a PIP < ____ by adjusting TV (avoiding major adjustments).
|
100%
30 |
|
If hypoxia develops during OLV you can compensate by?
|
-PEEP to dependent lung
-CPAP to non dependent lung -insufflation of O2 to non dependent lung |
|
Preop eval for common thoracic procedures include?
|
-lab tests
-prescreen for underlying pulm infection -tracheal stenosis, positional dyspnea, airway collapse, hypoxemia, anatomic narrowing? -review abg, PFT, CXR, V/Q scan, CT/MRI, angiography -coexisting patho |
|
Transfuse preop lung pt with pre op Hct less than __%
|
25%
-T and C 2-4 units of blood |
|
lung cancer patients may have myasthenic syndrome with increased sensitivity to __________.
|
non depolarizing muscle relaxants
|
|
When is the lateral decub position the aline should be in the ____ arm. When doing a mediastinoscopy the aline should be in the ____ arm.
|
dependent
right |
|
The central line should be in the ______side of neck. Pressure reading may be affected by open chest, lateral position and surgical manipulation.
|
non dependent
|
|
epidural anesthesia reduces volatile agents requirements but epidural anesthesia may create sympathetic blockade and ____.
|
hypotension
|
|
opening the chest produces _____.
|
pneumothorax
|
|
manipulation of the lung, heart, and major vessels may interfere with ______________________ intraop and post op.
|
ventilatory exchange and cardiovascular stability
|
|
the lateral decub position changes the distribution of blood flow and pattern of ventilation and exposes lower lung to danger of contamination by ____, ____ or ____.
|
secretions, blood or fluids
|
|
Open thorax surgery risks include...
|
-dysrhythmias
-DVT -PE -MI -bronchopleural fistula -chylothorax -subq emphysema -phrenic nerve injury -recurrent laryngeal nerve injury |
|
Small cell (oat tumors) account for ___% and non small cell tumors account for ____%.
|
20%
80% |
|
-Often proceeded by bronchoscopy/mediastinoscopy
-lateral or posterior lateral thoracotomy incision -lateral decub position -double lumen tube -time=2-3 hours -EBL= <500ml -post op care = ICU -careful attention to chest tubes -mortality= +/- 1% -pain score= 7-8 |
lung resection
|
|
intrapulmonary hemorrhage is characterized by massive hemoptysis r/t trauma, pulm artery rupture, erosion into vessel by trach, abcess or tumor. This requires immediate _____ with ____% FiO2, suctioning the airway, lung iso if unilateral involvement. May need thoracotomy and surgical repair
|
intubation, 100%
|
|
_____ ____ and ____ can be air filled, thin walled, bronchogenic or alveolar destructive, post infective, infantile or emphysematous cysts.
|
lung cysts & bullae
|
|
_____ may rupture cysts or bullae = tension pneumo
|
positive pressure
|
|
Once cysts or bullae are removed, _____ is usually improved.
|
respiration
|
|
key points to remember with cysts and bullae are...?
|
-PPV < 10cm (may need double lumen tube)
-No N2O -Extubation-smooth and without coughing |
|
____________ is an autoimmune disorder with prejunctional decreased Ach release and no improvements with anticholinesterases. The peripheral muscles and pelvis are most affected.
|
myasthenic syndrome-eaton lambert syndrome
|
|
The underlying malignancy of myasthenic syndrome is?
|
small cell cancer of the lung
|
|
Symptoms improve with ____ in myasthenic syndrome
|
exertion
|
|
muscle relaxants greatly affect myasthenic syndrome patients. ____ having the most effect.
|
NDMR
|
|
what is a broncho-pleural fistula?
|
abnormal communication between bronchial tree and pleural cavity with pus.
|
|
what causes a broncho-pleural fistula?
|
pulmonary resection, bronchus or bulla rupture, penetrating chest wound, lung cyst or empyema cavity.
|
|
the risks of bronco-pleural fistula are ____ may contaminate healthy lung or cause a tension pneumo.
|
PPV
|
|
The goal with a broncho-pleural fistula is to isolate the _____ lung with a double lumen tube (DLT). Also minimal gas leak through the fistula
|
affected
-lumen is to the unaffected side |
|
____ is indicated for stenosis, tumor or congenital defect.
|
tracheal resection
|
|
With a tracheal resection patient, you may note ____ and the flow volume loop may help you determine where the obstruction is.
|
wheezing
|
|
with tracheal surgery give minimal _____ to avoid airway obstruction.
|
premedication
|
|
for induction of tracheal surgery consider ______ induction or awake fiberoptic induction to avoid complete obstruction with loss of muscle tone. Questionable muscle relaxants.
|
inhalation
|
|
When emerging a tracheal resection, consider ____ the neck to reduce tension and reduce the risk of re-anastomosis
|
flexion
|
|
What are the three thoracoscopic procedures?
|
-bronchoscopy
-mediastinoscopy -bronchoalveolar lavage |
|
The complications of mediastinoscopy procedures include?
|
-#1 rupture/laceration of the major vessels
-#2 pneumo (hemo) thorax -intermittent occlusion of the innominate artery (CVA risk) -tracheal collapse, tension pneumomediastinum, mediastinitis, chylothorax -phrenic nerve/RLN injury |
|
anesthetic consideration with endoscopy are?
|
-small ETT vs. DLT
-laser tube and laser precautions -short acting hypnotic agent -inhaled agents vs TIVA -short acting narcotics -short acting muscle relaxants -local anesthesia post op |
|
With rigid bronchoscopy you should use _______. The risks/features of rigid include; hypercapnea, hypoxemia, air leaks, anesthesia machine vs HFJV, side arm ventilation port
|
general anesthesia
|
|
complications of endoscopy include?
|
-facial, dental and laryngeal injury
-airway rupture-pneumo -hemorrhage -airway obstruction-blood, edema |
|
_______ for thymectomy, medisinal masses, bilateral pulmonary resection.
|
median sternotomy/sternotomy
|
|
the _____ is the treatment of choice for myastinia gravis patients. it can be done through sternal incision or cervical approach.
|
thymectomy
|
|
_________ is an autoimmune diease with ocular, pharyngeal, and skeletal muscle weakness. It improves with edrophonium 10mg, corticosteroids, immunosuppresants, plasmapheresis and thymectomy.
|
myasthenia gravis
|
|
for myasthenia gravis patients they should hold their anticholinesterase med on _______.
|
the day of surgery
|
|
with myasthenia gravis patients neuromuscular monitoring is indicated but results can be ______.
|
misleading
|
|
myasthenia gravis pts may need to be vented post op if?
|
-duration of disease greater than 6 years
-coexisting COPD -anticholinesterase dose greater than 750mg/day |
|
resection of neoplasms, anti-reflux procedures and repair of traumatic or congenital lesions are all indications for?
|
esophageal surgery
|
|
with esophageal surgery you must consider...?
|
-chronic malnutrition related to cancer/swallowing difficulty
-hypovolemia related to swallowing -aspiration risk |
|
during esophageal surgery use an aline, CVP and _____. DLT may be indicated and epidural analgesia can be used ____ and _____.
|
foley
intraop and post op |
|
postoperatively pts with esophageal surgery may need to stay intubated for _________.
|
aspiration precations
|
|
When using the DLT, DL with a ____ MAC blade and advance the tube to at least the ___ cm mark.
|
3
26cm |
|
what is the most common error associated with DLT insertion?
|
advancing the tube too far in the bronchus and causing only distal lumen ventilation to one lung
|
|
the amount of ____ is the main component of oxygenation. HPV may limit ___ unless it is blunted.
|
shunt
shunting |
|
The greatest risk of OLV is _________. With that in mind:
TV= 8-10 ml/kg Adjust RR to keep PaCO2= 40 No PEEP (or less than 5) Continuous monitoring of O2 and ventilation (SpO2, ABG, ETCO2) if pulse ox is less than 94% recheck DLT or BB |
hypoxemia
|
|
What is the O2 management of OLV
|
-minimize ventilated lung atelectasis
-D/C or avoid N2O to maintain PaO2 -check tube position and suction prn -PEEP to vented lung (may shunt blood to non ventilated lung) -CPAP to nonventilated lung (5-8cmH2O) -Reinflate nonventilated lung with 100% fio2 or have surgeon clamp the PA (last resort) |
|
Intraop blood and fluid requirements of OLV
|
-IV 2 large bore
-central line -aline -restrict IV fluids (1000-1500 ml NS/LR max) -1 unit autologous blood if available -vasopressor if hypotensive -ephedrine 5-10mg -phenylephrine 50-100mcg |
|
after positioning the patient?
|
reassess breath sounds, vital signs, monitors, lines and IVs
|
|
when the surgeon is finished lung re-exapnsion is done by _____ ventilation, stacking breaths with increasing pressure.
|
hand
|
|
filling the chest with water to determine if there is a leak in the lung is known as the?
|
lung bubble test
|
|
decrease ____ during closing to avoid injury while suturing.
|
TV
|
|
inflating the lungs to 30 cm H2O not only checks for leaks but it also reinflates areas of ____.
|
atelectasis
|
|
the surgeon will insert ______ and drain the pleural cavity and aid in lung re-expansion.
|
chest tubes
|
|
The patient is usually extubated in the OR but if they are remaining intubated, exchange....?
|
the double lumen tube for a single lumen ETT
|
|
chest tubes can be set to water seal or ____cmH2O. Except in pneumonectomy=water seal only.
|
20
|
|
the patient will be transferred to the _____ on monitors and nonrebreathing mask.
|
ICU
|
|
Things to remember...
|
-watch your field
-interact with your surgeon |
|
A right DLT is rare but it has an extra murpheys eye to ventilate the?
|
right upper lobe
|
|
the gold standard for DLT placement is?
|
fiberoptic confirmation
|
|
When scoping down a DLT you use a ____ scope.
|
peds
|
|
with thoracic surgery it is better to give ____ for fluid replacement/drop in BP
|
colloids
|
|
when inserting an ETT for bronchoscopy, you should have the _____ tube possible.
|
largest
|
|
the blue cuff on the DLT sits in the _____ and the white cuff sits in the _____. the stylet goes through the _____ lumen because it is longer.
|
bronchus
trachea bronchial/blue |