Respiratory tract surgery (Yr4) Flashcards
what are contraindications for draining the thorax?
if patient isn’t stable
ongoing haemothorax
clinically insignificant volumes
what is atelectasis?
lung collapse
how will lung sounds change if you have a pleural effusion?
they will be decreased ventrally but increased dorsally depending on where the fluid line is
what are the two methods of draining the thoracic cavity?
needle thoracocentesis (one off drainage/sample)
trocar thoracostomy tube or small bore multi-fenestrated thoracotomy (repeat drainage)
where is the needle placed for needle thoracocentesis?
7th-9th intercostal space (dorsal third if air, ventral third if fluid, mid third if combination)
on which side of the rib should you place the butterfly needle for needle thoracocentesis?
cranial aspect (avoid the vessels/nerves)
what equipment is required for needle thoracocentesis?
aseptic preparation and local
butterfly needle
3 way tap
syringes
EDTA tube (cytology) and plain tube (culture)
where do the intercostal arteries, veins and nerves run in relation to the ribs?
on caudal aspect (always place needles on cranial aspect)
where is a thoracostomy tube placed?
7th or 8th rib space (on cranial border of rib)
how long should a thoracostomy tube be?
run from 2nd rib to 7th/8th/9th rib
where should the skin be incised for trocar-type chest drains?
10th/11th intercostal space to then tunnel cranially and enter though 7th/8th intercostal space
what should be done post-placement of a thoracostomy tube?
x-ray to check position
analgesia, body vest, elizabethan collar, monitor respiratory rate/effort and insertion site
when would it be appropriate to remove a thoracostomy tube?
when draining <2ml/kg/day fluid
when draining no air
(based on patient status and disease process)
when is a temporary tracheostomy tube indicated?
for life-threatening upper airway obstruction (BOAS, laryngeal paralysis, laryngeal foreign body, neoplasia)
how is a permanent tracheostomy done?
suture tracheal mucosa for the skin
