Post Op atelectasis

Question 1

Describe atelectasis

Answer 1

An abnormal condition of the lungs characterized by partial or total collapse of previously expanded alveoli

Question 2

What is the result of atelectasis?

Answer 2

Reduced gas exchange in the collapsed lung units and reduced compliance

Question 3

What are some common minor post operative pulmonary complication?

Answer 3

Atelectasis
Bronchospasm
Pneumonia
Acute upper airway obstruction
Exacerbation OSA

Question 4

What are common (but more severe) post operative pulmonary complications?

Answer 4

Pleural effusion
Chemical pneumonitis
Pulmonary embolism
Abdominal compartment syndrome
Tracheal laceration or rupture

Question 5

What factors increase a patients chance for developing post operative atelectasis?

Answer 5

Obesity
Operative and post operative supine positioning
Advanced age
Use of inadequate tidal volumes during mechanical ventilation

Question 6

What are the “levels” atelectasis and how common are they?

Answer 6

Micro atelectasis/subsegmental atelectasis = very common
Segmental atelectasis = fairly common
Lobar atelectasis = uncommon
Entire lung collapse = very rare

Question 7

What portions of the lung most commonly experience post operative atelectasis?

Answer 7

20-25% of lung tissue in the basal lung area collapses after induction with general anesthesia

Question 8

What are the two types of atelectasis

Answer 8

Obstructive
Non-obstructive

Question 9

Describe compression atelectasis

Answer 9

A “space occupying lesion” develops in the pleural space and puts pressure on lung units resulting in collapse

Question 10

Describe obstruction atelectasis

Answer 10

Airway is obstructed, if collateral flow doesnt exist or is inadequate, the obstructed unit will collapse

Question 11

Give some examples of compression atelectasis

Answer 11

Pneumothorax
Hemothorax
Pleural effusion

Question 12

Describe relation atelectasis

Answer 12

Contact between the parietal and visceral pleura is lost and the elastic recoil of the lung pulls it inward collapsing the lung units

Question 13

When could a patient experience relaxation atelectasis?

Answer 13

Pleural effusion
Pneumothorax
Loss of surfactant

Question 14

Describe cicatricial atelectasis

Answer 14

Cicatrix = scar
Parenchyma becomes scarred and collapse as a result

Question 15

What processes could cause cicatricial atelectasis?

Answer 15

Diseases that form granulomas (sarcoid)
Necrotizing pneumonia
Radiation pneumonitis

Question 16

How is post operative atelectasis diagnosed?

Answer 16

Clinical diagnosis drawn from signs and symptoms and reinforced with imaging

Question 17

Describe replacement atelectasis

Answer 17

Alveoli of lung units become filled with tumor tissue

Question 18

How might a patient with post op atelectasis present?

Answer 18

Elevated vital signs
Cyanotic
Diaphoretic

Question 19

What features of a chest assessment would indicate post op atelectasis?

Answer 19

Increased tactile or vocal fremitus
Dull percussion notes
Bronchial breath sounds
Diminished breath sounds
Crackles
Whisper pectoriloquy

Question 20

What features or a CXR would indicate post op atelectasis?

Answer 20

Increased density in areas of atelectasis
Air bronchograms
Elevation of diaphragm on affected side
Tracheal or mediastinal shift toward the affected side

Question 21

Increased density in areas of atelectasis
Air bronchograms
Elevation of diaphragm on affected side
Tracheal or mediastinal shift toward the affected side

Answer 21

Post op atelectasis

Question 22

A patient with post operative atelectasis has relatively few secretions but is having trouble taking deep breaths. What treatment options would be best for them?

Answer 22

CPAP

Question 23

A patient with post operative atelectasis has excessive secretions but is having trouble taking deep breaths. What treatment options would be best for them?

Answer 23

Airway clearance
ENT suctioning
Oral suctioning
OPEP
CPT
Bronch

Question 24

A patient who has post op atelectasis from pleural effusions. What would be the best way to treat the atelectasis?

Answer 24

By treating the pleural effusions with either diuretics or a thoracentesis