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25 Cards in this Set

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what are the surgical approaches to the thorax?
lateral throacotomy
median sternotomy
transthoracic- bilateral lateral thoracotomy connected across sternum
in both the right and left lateral thoracotomy, where would you try to get to the heart?
all the heart stuff is at the 4th ICS
(cardiopulmonary bypass, PDA, PS, PRAA, pericardium)
which side would you go for to do a PDA, PS, PRAA?
left lateral
what side would you go for to do a cardiopulmonary bypass?
right lateral
what does thoracotomy mean? Just for the sake of the last exam one letter makes a huge difference in these words.
an incision into the pleural space
where would you go to get to the cranial lung lobes on either side of the thorax?
5th ICS
where would you go to get to the intermediate lung?
6th ICS on the right side :)
where would you go to get to the caudal lung on either side of the thorax?
7th ICS
where would you go to get to the thoracic duct in a dog? in a cat?
Dog- 8th ICS RIGHT side
Cat- 8th ICS LEFT side
where woudl you go to get to the caudal esophagus?
9TH ICS on the left side
which muscles are you going to be transecting when you go into the 4th ICS to place a throcostomy tube ?
cutaneous m.
latissimus dorsi m.
what muscle are you going to bluntly seperate, ventral to dorsal while getting through the 4th ICS?
serratus ventralis m.
what is the last m. you're going to cut through before getting to the pleura in the 4th ICS?
intercostal mm. transect ventral to dorsal
so when you want to place this thoracostomy tube and you've already put a nice hole in the pleura, whats next?
put the tube in, preplace sutures around the ribs and tie, close up the muscles except the intercostal mm., and routine closure of the skin
so what don't you close or do when after you placed your thoracostomy tube?
dont close the intercostal muscles
dont overlap the ribs
after you put this tube into the 4th ICS you have to move it a bit, what do you do?
go 2-3 ICS dorsal and caudal to the original incision and make a nice stab incision.
after you make your stab incision where are you going to tunnel your tube?
tunnel cranially 1-2 ICS, enter the pleural space, and position the tube into the thorax
how are you going to secure this tube after you tunnel it?
either a purse string suture or a chinese finger trap suture in the skin around the tube
after you have your thoracostomy tube in, what is the post op care?
maintain the chest tube until the pleural space is free of air and fluid.
what type of analgesia would you give to your patient you just put a thoracostomy tube in?
intercostal nerve blocks
narcotic analgesics
interpleural bupivicane
what are indications for a median sternotomy?
access to the entire lung field for exploratory surgery, subtotal pericardectomy, aortic valve replacement
how would you close a median sternotomy with a throacostomy tube?
the thoracostomy tube is placed, sternebrae closed with orthopedic wire in figure 8 pattern
remaining tissue is closed routinely
how do you place a thoracostomy tube via a median sternotomy?
a stab incision is made over the 7th-9th intercostal space
tunnel cranially 1-2 spaces to enter the pleural cavity
what are the advantages of a median sternotomy?
access to entire thoracic cavity
what are the disadvantages of a median sternotomy
more lengthy and more difficult procedure.
increased morbidity
more severe post op pain
more severe physical dysfunction- patient may be unable to ambulate without assistance