Thorax Flashcards
(11 cards)
What causes diaphragmatic rupture in trauma cases?
A blow to the abdomen with an open glottis forces abdominal organs into the thoracic cavity, exceeding diaphragm strength and causing a tear.
Which part of the diaphragm is most commonly torn in diaphragmatic rupture?
The muscular portion is more commonly torn than the tendinous portion.
What are the diagnostic signs of diaphragmatic hernia on physical exam and imaging?
Dull or muffled heart/lung sounds, borborygmi in the chest, ‘empty’ abdomen, and radiographic evidence of gas-filled abdominal organs in the thorax.
When is surgery for diaphragmatic hernia most risky?
Very early post-trauma (due to anaesthesia risk with lung contusions) or >48 hours post-injury (due to risk of re-expansion pulmonary oedema).
List key anaesthetic precautions before diaphragmatic hernia repair.
Pre-oxygenate, elevate head to shift viscera caudally, clip pre-induction, have surgical team ready, delay dorsal recumbency, monitor closely post-intubation.
How should large defects in the diaphragm be repaired if simple closure is not possible?
Use autologous tissue (e.g., muscle flap, pericardium) or synthetic mesh if autologous tissue is unavailable.
What is the preferred method for re-expanding lungs after diaphragmatic hernia surgery?
Gradual drainage of pleural air with a drain or catheter; avoid hyperinflation to prevent re-expansion pulmonary oedema.
What are common indications for lung lobectomy?
Trauma (e.g., bite wounds), pulmonary neoplasia, bullae/blebs, or devitalised lung tissue (e.g., from diaphragmatic hernia).
When is a partial vs. complete lung lobectomy indicated?
Partial lobectomy is for marginal lesions; complete lobectomy for more diffuse or hilar-involved pathology.
What tools are preferred for lung lobectomy and what alternatives exist?
Staplers (e.g., TA or vascular staplers) are preferred; pretied ligature loops or sutures (continuous or mattress) are alternatives.
What is used to test for leaks before thoracic closure after lung surgery?
Warm saline fill and observation for air bubbles during ventilation; patch leaks as needed.
