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;
19 Cards in this Set
- Front
- Back
What physiologic effects can mediastinal masses have on the body?
|
-compress vital structures
-cause changes in C.O., obstruction to airflow, atelectasis, or central nervous system changes |
|
What are the "4 Ts" of Mediastinal Masses?
(common masses) |
-Thymomas
-Thyroid -Teratoma -"Terrible" lymphoma |
|
Tumors located where; can cause compression of the trachea or bronchi, increasing resistance to airflow
|
anterior mediastinum
|
|
What things (CRNA controlled/external factors) can cause changes to airway dynamics in a pt with a mediastinal mass causing collapse of the airway with total obstruction to flow?
|
-supine positioning
-induction of anesthesia -PPV |
|
Is it a guarantee that a person can be mechanically ventilated when the have a mediastinal mass?
|
NO: if the mass encroaches on the airway distal to the endotracheal tube
(CT or bronch may be used to place tube below mass) |
|
What is the primary goal for a pt presenting with mediastinal mass
|
maintaining spontaneous ventilation
|
|
What are common symptoms of Mediastinal Mass
|
-sweats
-syncope -orthopnea -hoarseness -inability to lie flat -chest pain or fullness -superior vena cava obst -cough (especially when supine)**symptoms may be worse in the supine position* |
|
What test can be done to delineate the size and effects of masses
|
CT, TEE, MRI
|
|
What PFTs can alert the provider to increased risk of obst. perioperatively
|
decreased maximal insp or exp flow rates
|
|
What type of anesthesia should be used during the surgery for the biopsy of masses if there is any sign of respiratory obstruction
|
local anesthesia whenever possible
|
|
What type of Rx is suggested before surgery to reduce the risk of airway obstruction
|
Radiation to decrease mass bulk in radiosensitive tumors
|
|
What is the first choice for intubation and why?
|
awake fiberoptic
b/c it enables the provider to evaluate the lg airways for obstruction and to place the tube beyond the obstruction while maintaining spont ventilation |
|
What are emergency strategies that may become necessary in the case of airway compromise
|
-repositioning
-awakening the pt -rigid bronchoscopy -sternotomy with manual decompression of the mass off the airway in the case of life threating compromise |
|
Mediastinal masses can cause compression of great vessels or cardiac chambers.
|
..
|
|
Compression of which artery is rare; however, can lead to sudden hypoxemia, hypotension, or cardiac arrest
|
pulmonary artery is rare
|
|
What are the 3 goals in treating someone with cardiac or great vessel involvement
*If GA is required, what should be done prior to surgery? |
-local only (whenever possible)
-remain in sitting position -maintain spont ventilation Placement of femoral ports for emergent ECMO |
|
Venous engorgement of the upper body caused by compression of the superior vena cava by a mass
|
superior vena cava syndrome
|
|
Superior vena cava syndrome leads to the following S/S
|
dilation of collateral veins of the upper part of the thorax and neck
-edema and rubor of the face, neck, and upper torso and airway -edema of the conjunctiva -shortness of breath -headaches -visual distortion -altered mentation |
|
Where should you place your IV lines in someone who has superior vena cava syndrome
|
lower extremities b/c insertion in sites above the SVC could delay the drug effect as a result of slow distribution
|