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Surgery 2 > Lecture 24: Thoracic Trauma (Exam 3) > Flashcards

Lecture 24: Thoracic Trauma (Exam 3) Flashcards

(51 cards)

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1
Q

What does M^2ARCH^2E stand for?

A
  • Massive hemorrhage/muzzle
  • airway
  • respiration
  • circulation
  • head injury & hypothermia
  • evacuation/pain management/abx
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2
Q

(Tigger Case) Whats abnormal in this radiograph?

A
  • easy to see esophagus, aorta and caudal vena cava = air in mediastinum from trauma
  • damage to trachea
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3
Q

(Tigger Case) How will you approach damage to the mediastinum?

A

medial sternotomy

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4
Q

(Tigger Case) How do you anesthetize the cat with airway damage?

A

quickly!

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5
Q

(Tigger Case) How do you repair a torn trachea?

A
  • place stay sutures
  • anastamose trachea entirely with simple interrupted sutures (around cartilage)
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6
Q

(Tigger Case) Are strictures a big problem in tracheas?

A

No because of the tracheal rings

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7
Q

(Tigger Case) just appreciate the difference of the before (top) after (bottom)

A
  • top had torn trachea
  • bottom is surgically anastomosed trachea
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8
Q

What causes pneumothorax?

A
  • blunt thoracic trauma
  • penetrating trauma
  • spontaneous
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9
Q

What causes spontaneous pneumothorax?

A
  • ruptured abscesses
  • ruptured tumor
  • ruptured bulla
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10
Q

What is the red pointer on in this photo?

A

Bulla on the lung

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11
Q

What percent of blunt trauma induced pneumothorax do well and resolve with surgery?

A

95%

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12
Q

Define

Tension Pneumothorax

A

rapid accumulation of air in the pleural space that results in positive intrapleural pressure (LIFE THREATENING)

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13
Q

What is the Treatment of tension pneumothorax

A
  • thorocentesis
  • chest tube if necessary
  • oxygen necessary
  • cage rest
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14
Q

What are the landmarks for needle decompression (thoracocentesis) of a tension pneumothorax?

A

7th - 10ths ICS

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15
Q

What do the lungs do when you pull the air out using thoracocentesis?

A

inflate

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16
Q

What modification would you make to prevent the lung from getting stabbed with needle when lungs reinflate?

A
  • catheter over needle
  • pull needle out before pulling air out
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17
Q

Why do you go two ICS between hole and chest wall when placing a chest tube?

A

to create dead space to keep air from going through

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18
Q

(Harley’s case) What could this be?

A

Abscess from weakened immune system

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19
Q

(Harley’s case) This x-ray was taken after the first set and Harley’s dyspnea worsened. What happened to the abscess?

A

Ruptured

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20
Q

(Harley’s case) What surgical approach would you utilize to access this abscess?

A

lateral thoracotomy

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21
Q

(Harley’s case) How can you repair a whole in the lung?

Study These Flashcards
A

partial lobectomy or full lobectomy

22
Q

How much lung can you remove for the dog to lead a “normal” life?

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A

all of left lung OR 2-3 of 4 lobes on the right lung

23
Q

(Harley’s case) How do you remove the contents of the ruptured abscess from the thorax?

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A

warm lavage & antibiotics

24
Q

What does this xray show?

Study These Flashcards
A

pulmonary contusion (pactchy densities, air bronchograms)

25
What is a pulmonary contusion?
"bruised" lung
26
What do you hear upon auscultation of a pulmonary contusion?
crackles
27
What usually causes pulmonary contusions?
blunt trauma
28
How do you treat pulmonary contusions?
* oxygen * rest * bronchodilators
29
# **Define** hemothorax
bleeding into pleural space
30
What causes hemothorax?
* ruptured vessel or heart * blunt or penetrating trauma * neoplasia
31
What is the treatment for hemothorax?
* treat shock * drain blood * autotransfusion * blood transfusion
32
What is shown in this xray?
rib fractures
33
How do you treat rib fractures?
* cage rest * analgesics
34
When do you perform surgery on rib fractures?
* if affecting ventilation * risk of lung trauma
35
# **Define** Flail Chest
multiple rib fractures that result in an unstable segment for chest wall
36
What do you see on PE with flail chest?
paradoxical chest wall movement of unstable segment
37
What is seen here?
paradoxical chest wall movement of flail chest
38
What condition is seen in these x-rays?
flail chest treatment
39
What is a diaphragmatic hernia?
increase in abdominal pressure and abdominal contents travel into thoracic cavity
40
What organ is seen in the chest xray here?
stomach
41
What is the exception to the rule "don't cut diaphragmatic hernia the day it was injured"?
when the stomach is in the thorax and dilating
42
What is the common viscera found in a diaphragmatic hernia?
* liver * spleen * bowel * stomach * omentum
43
What is shown in this image?
* Peritoneopericardial diaphragmatic hernia * congenital communication between abdomen and the pericardial sac
44
how do you treat a diaphragmatic hernia?
* ventral midline approach * reduce hernia contents back into abdomen * simple continuous to close diaphragm * take a day or two to stabilize patient * not emergency surgery unless stomach dilating in thorax
45
What is wrong with bubba?
congenital diaphragmatic hernia
46
How can you tell Bubba had a congenital diaphragmatic hernia?
* he presented for a UTI * no complaints about his breathing * narrow abdomen
47
Would you fix Bubba's hernia?
no there might not be room in abdomen for it
48
What could happen if you flip Bubba's liver?
* hemodynamically change blood flow * kill blood supply to mesenteric arteries
49
What's wrong with Josie
**ARROW IN HER FREAKING HEART BRO**
50
What surgical approach would you use to take out the arrow from Josie's heart?
Median sternotomy
51
(**Josies case**) How do you remove the arrow?
purse string around the arrow holes and pulled out the arrow as they tightened the purse strings

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