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Physiotherapy, Cardiorespiratory > cardiacthoracic surgery > Flashcards

Flashcards in cardiacthoracic surgery Deck (48)
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1

surgical management

anohter growing area in surgery is lung volume reduction surgery - for those whith huge hyper inflation issues.

2

common thoracic surgicsl procedures

lungs - theyre anatomy is in secgments and lobes which makes it esier to remove.

3

lung carcinoma

mostcommon cells - sqaumous and adencarcinoma - can be improved from trearment before surgery. small cell spread very quickly.

4

clinical signs ofthroraccic cancer

cough- becomes slightly different
bone or breast cancer can matistisize to lungs. so can get short breath
getting rid of luymph nodes helps stopping it from spreading and matestising

5

other clinical signs

plura fdvsv-most common symptom

6

investigations

BAL - sputum cytlogy to collect sample of sputum

7

staging

TNM scoring sytem for how the score cancer for all types of cncer. T,N lymph node involvent, MT2 may mean tht the tumour is bigger.
so improtant frifor the MDT and planning treatment; good for research categorising; whi needs surgery? or needs treatent more thn surgery?

8

thoracotomy

on the side and in the middle to allow best access and space

9

thoracic surgicsal

b

10

lobectomy

sometimes were restricted on how far we ca move them cus theyre on suction, so may have to use pedals and be creative with how to mobilise. These chest darins are kept in till theres no air leak or fluid left in the lungs. get patient to cough to see if there is still an air leak.

11

pneumonectomy

take whole lung out then sew up bronchial stump.

12

physiotherapy - pneumon

high mortality - many die. claeful to prtect that stump

13

physiotherapy - pneumon

high mortality - many die. claeful to prtect that stump. these patients are very compicated. dont need pneumo for exam just good to know whst to do

14

lung volume redcution surgery

look at link.
strict criteria for this surgery and nice guidlines. very few procedures perfomred

15

copd patients

cant breath out. always hyper inflated. e.g breathe in thrugh a straw. little quality of life. no exercise tolerance

16

x ray

left side - small diaghram, no space, restricted not enough lungvolume. Right side - healthy and spaced diaphram.

17

pre op physiotherapy

select patients caefully as its such a risky surgery. Cant have any infections. can cuse numerthoracies from the high pressure as a pre op patient.

18

post op physiotherapy

although have big volume now they have a lack of pulmoary reserve.
ABGs not nromal so find whats normal results fro them individually. Want to aim to send them out with a better quality of life.

19

links

shows how thr specialists role as a physio need to do whats best or pateitns

20

chst wall surgery - pecus excavatum

Noramlly these patients have lung dieseas - as lung volumes small. resticed type of lung diease because no not enough space for lung to exand to - same with scolerosis. also after surgery there will be further loss of lung volume. often young and in pain patients, struggle to trsut. have big issues with sats.

21

pecus carinatum / pigeon chest

Plastics get involved in these surgeries - changing shape of cartilage. often young and in pain patients, struggle to trsut. have big issues with sats.

22

thoracoplasty

not done anymore, but shwos the role of evidence and evolving evidence base.

23

pleural surgery

pleuradesis etc

24

pleurodesis

iodise talc, stick the pleura together

25

pleuroectomy

strip off perital pleura

26

thoracic surgery complictions

risk of inflamatary response - in thoracotomies. Some patients comeback atrial fibrillation - comprimising there blood pressure. all these avoided trhough early rehab

27

surgical emphysema

- for patients whove had trauma, numathorax.

28

thoracic trauma - classification

these patients have surgical emphysemas

29

thoracic injuries

if break in more than one place you get a flail chest. fractures causes bruising of the lung tissure too.

30

flail chest

when breahting in can go the wrong way

31

x ray

all the ribs on left side are fractured and broken in more than one place, flail

32

punctured lung
pulmonary contusions.

cant par take in gaseous exchange due to exidate around it when you have a punctured lung as so much brusing. pulmonaey enfusion - bruising of lungs. sometime hve to be intubated and ventilated if cant improve gaseous exchange. this will by them time for them to heal. called a blunt lung injury cus its a secondary problem - high risk of pneumonia. more white in x ray ( right) cuase more fluid.

33

pneumothorax

other types of it too.

34

cxr pneumothorax

starts to push and compress heart, pneumothroax tension which is when cardiac gets involved.

35

haemothorax

cant hear anything.
need to drain, so chst drains. on CT scan left side - blsck bit is air in space and white bit at bottom isthe blood. normal lung in midddel but free aire haemopneumothrax in back oaboe as that is free air.

36

haemothorax

cant hear anything.
need to drain, so chst drains. on CT scan left side - blsck bit is air in space and white bit at bottom isthe blood. normal lung in midddel but free aire haemopneumothrax in black, above lung, as that is free air.

37

haemothorax

cant hear anything.
need to drain, so chst drains. on CT scan left side - blsck bit is air in space and white bit at bottom isthe blood. normal lung in midddel but free air, which is the haemopneumothrax, in black, above lung,

38

what vids for explain how chest drains work. will come in in vivas of what to do when trying to mobilise while keeping safe when patents has chest drains.

vids

39

physiotherpy managemtn in cardiothoracic sugey

on sheet on brown notes

40

post op phydiotherpy

think about the shoulder!!!! when havinga thoracic patient!! dont want a frozen shoulder as patients can cure towards it if in pain etc.

41

pre op

getting nurses and surgeons/doctors on board with your plan

42

secretion clearance

a

43

supported coughing

very important to teach them as patients dont want to cough.

44

scj

dont let patient out of bed too much . do two tratemtsn a bit shorter as this will strength lung volume more but dont want to get them too tired

45

physiotherapy key points

pc

46

mangement

progressing patients
mobility!!!! rehab

47

heart transplant

v

48

lung transplant

v both transplants have all the same physiotherapy managemt as csrdiothoracic surgery management