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25 Cards in this Set
- Front
- Back
what are the surgical approaches to the thorax?
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lateral throacotomy
median sternotomy transthoracic- bilateral lateral thoracotomy connected across sternum |
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in both the right and left lateral thoracotomy, where would you try to get to the heart?
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all the heart stuff is at the 4th ICS
(cardiopulmonary bypass, PDA, PS, PRAA, pericardium) |
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which side would you go for to do a PDA, PS, PRAA?
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left lateral
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what side would you go for to do a cardiopulmonary bypass?
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right lateral
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what does thoracotomy mean? Just for the sake of the last exam one letter makes a huge difference in these words.
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an incision into the pleural space
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where would you go to get to the cranial lung lobes on either side of the thorax?
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5th ICS
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where would you go to get to the intermediate lung?
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6th ICS on the right side :)
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where would you go to get to the caudal lung on either side of the thorax?
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7th ICS
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where would you go to get to the thoracic duct in a dog? in a cat?
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Dog- 8th ICS RIGHT side
Cat- 8th ICS LEFT side |
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where woudl you go to get to the caudal esophagus?
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9TH ICS on the left side
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which muscles are you going to be transecting when you go into the 4th ICS to place a throcostomy tube ?
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cutaneous m.
latissimus dorsi m. |
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what muscle are you going to bluntly seperate, ventral to dorsal while getting through the 4th ICS?
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serratus ventralis m.
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what is the last m. you're going to cut through before getting to the pleura in the 4th ICS?
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intercostal mm. transect ventral to dorsal
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so when you want to place this thoracostomy tube and you've already put a nice hole in the pleura, whats next?
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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
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so what don't you close or do when after you placed your thoracostomy tube?
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dont close the intercostal muscles
dont overlap the ribs |
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after you put this tube into the 4th ICS you have to move it a bit, what do you do?
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go 2-3 ICS dorsal and caudal to the original incision and make a nice stab incision.
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after you make your stab incision where are you going to tunnel your tube?
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tunnel cranially 1-2 ICS, enter the pleural space, and position the tube into the thorax
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how are you going to secure this tube after you tunnel it?
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either a purse string suture or a chinese finger trap suture in the skin around the tube
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after you have your thoracostomy tube in, what is the post op care?
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maintain the chest tube until the pleural space is free of air and fluid.
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what type of analgesia would you give to your patient you just put a thoracostomy tube in?
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intercostal nerve blocks
narcotic analgesics interpleural bupivicane |
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what are indications for a median sternotomy?
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access to the entire lung field for exploratory surgery, subtotal pericardectomy, aortic valve replacement
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how would you close a median sternotomy with a throacostomy tube?
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the thoracostomy tube is placed, sternebrae closed with orthopedic wire in figure 8 pattern
remaining tissue is closed routinely |
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how do you place a thoracostomy tube via a median sternotomy?
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a stab incision is made over the 7th-9th intercostal space
tunnel cranially 1-2 spaces to enter the pleural cavity |
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what are the advantages of a median sternotomy?
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access to entire thoracic cavity
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what are the disadvantages of a median sternotomy
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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 |