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Flashcards in pulmonary Deck (30)
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1

postoperative pulm complications

1. atelectasis, 2. infection
3. bronchospasm
4. exacerbation of chronic lung disease
5. prolonged mechanical ventilation

2

RF for postoperative pulm complications

1. older than 50
2. emergency surgery or duration more than 3 h
3. HF
4. COPD
5. Poor general health

3

preoperative strategies to reduce the risk of postoperative pulm complications

1. smoking cessation at least 8 wks prior
2. symptom control of COPD
3. Treatment of any resp infections prior
4. patient education for lung expansion maneuvers

4

postoperative strategies to prevent posoperative pulm complications

1. incentive spirometry (the best)
2. deep breathing exercise
3. epidural analgesia instead of paraenteral opioids
4. Continuous positive airway pressure

5

flail chest - pathophysiology

3 or more continguous ribs fractured in 2 or more locations

6

flail chest findings

paradoxiccal chest wall motion with respiration
chest pain, tachypnea, rapid shallow breaths
CXR: rib fractures +/- contusion/hemothorax

7

Management of flail chest

pain control, O2
positive pressure ventilation if resp failure

8

clinical indicators of thermal and smoke inhalation injury include

1. Burns on the face
2. singeing of the eyebros
3. oropharyngeal infl
4. blistering or carbon deposits
5. STRIDOR
6. HbCO levels more than 10%
7. History of confinement in a burning building

9

evaluation of bleeding

- rule out other causes
A. mild to moderate --> chest x-ray, CBC, coagulation studies, renal function, urinalysis, rheumatologic workup --> treat cause
--> CT scan +/- bronchoscopy (depends on image results
B. Massive (more than 600/24h or 100ml/h) --> secure ABC: If bleeding stops --> (x-ray, CBC etc), if continues --> treat cause

10

positive pressure mechanical ventilation in a patient with hemor shock

increased intrathoracic pressure --> further decreased Venous return --> cardiac arrest

11

spontaneous pneumothorax - management

2 cm or smaller: observation + O2
large + stable: needle aspiration or chest tube

12

EF in hypovolemic shock

increased

13

Diaphragmatic rupture?

more common in the lest
- resp distress and can have deviation of the mediastinal contents to the opposite side, elevation of the hemidiaphragm on the chest x-ray might be the only abnormal finding
- also nasogastric tube in the pulm cabity is diagnostic

14

important step in the management of ribs fracture

adequate analgesia --> prevent hypoventilation (and so atelectasis or pneumonia)

15

septic shock - HCO3-?

only in ph under 7.2

16

pulmonary contusion - clinical features

present less than 24 h after blunt thoracic trauma
- tachypnea, tachycardia
- HYPOXIA

17

pulm contusion - diagnosis

- rales or decreased breath sounds
- CT scan (most sensitive) on CXR with patchy, alveolar, infiltrate not restricted by anatomycal borders

18

pulm contusion - management

pain control
pulm hygiene (eg. nebulizer treatment, chest PT)
O2 + ventilatory support
avoid fluids / use diuretics

19

chest xray suggestive for diaphragmatic rupture - next step

chest and abdominal CT

20

massive hemoptysis - definition

more than 600 ml / d
or more than 100ml/h

21

bleeding lung in the dependent position

lateral position

22

tracheobronchial tear - sign

Hamman sign --> audible crepitus on cardiac ausculation
sternum tenderness

23

spontaneous pneumothorax - types

1ry: no preceding event or lung disease, thin young men
2ry: underlying Lung disease

24

signs and symptoms of spontaneous vs tension pneumothorax

spontan: chest pain, dyspnea, diminished breath sounds and chest movement, hyperresonance
tension: SAME + hemodynamic instability, tracheal deviation away

25

imaging on spontaneous vs tension

spontaneous: absent lung marking, visceral pleural line
tension: SAME + mediastinal shift + ipsilateral hemidiaphragm flatterning

26

another cause of fat embolism

pancreatitis

27

persistent bleeding after bronchoscopy

embolization

28

massive hemothorax is defined as

more than 1.5 L

29

postoperative atelectasis - days

2 + 3

30

postoperative fever - MNEMONIC

Wind (day 1-2) (lungs): Atelectasis, postoperative pneumonia
Water (day 3-5): UTI
Walk (day 5-7): DVT / PE + IV ACCESS LINES
Wound (day 7): surgical site infection
Weird (8-15): drug fever or deep abscess
Wonder (drugs/products): drug fever, blood products, IV lines