Week 7 (parts 1 and 2) Flashcards

Question

what is the costophrenic angle

Answer 1

 Angle formed by lungs and ribs  Obliterated by:  Meniscus of small pleural effusion  (200 ml. of fluid needs to accumulate in the pleura before blunting the costophrenic angle)  Patchy shadowing of consolidation  Chronic atelectasis  Lung hyperexpansion (pushes diaphragm domes down, rounding the angle)

Answer 2

› Soft tissue › Lines/ airways

Answer 3

 Endotracheal Tube  Tracheostomy / Mini-trach  Nasogastric tube  ECG leads  Central line  Chest Drain  Other

Answer 4

 Vertebral bodies visible to mid heart level  Overexposure:  Too black: low density lesions missed  Underexposed:  Too white:  Patients ability to take adequate inspiration will effect chest xray

Answer 5

 Diffuse shadowing  Ground glass (hazy density like a thin veil over the lung suggests an alveolar pathology)  Reticular or a coarse honeycomb pattern, representing progressive damage in interstitial disease  Peripheral fanning out from the hila, suggests pulmonary oedema  The snowstorm appearance of Acute Respiratory Distress Syndrome  Localised opacities:  Consolidation (patchy opacity)  Bronchial tumours (usually located proximally)  Metastases (scattered)  Fibrosis (streaky shadowing)  Unilateral white-out (dense opacities)  Causes  Lung collapse, pneumonectomy (pull the mediastinum towards the lesion)  Large pleural effusion (may push the mediastinum away from it)  Collapse (atelectasis)  Increase density of collapsed lung  Shift of features  Silhouette sign (border of a structure is lost)  Hilar shift  Crowding of vessels  Mediastinal shift  Crowding of ribs  Elevation of hemidiaphragm

Answer 6

 Collapse (atelectasis)  Loss of aeration so loss of lung expansion  Increased tissue denseness due to lung squashing down  Collapse due to:  Tumour  Inhaled foreign body  Mucus plug  Structure Positioning  Fissure shift  Diaphragm raising  Tracheal Shift  Heart/mediastinal shift  Rib crowding

Answer 7

 ↑ opacity  No air bronchograms  Shifting of structures

Answer 8

 Little challenging to identify.  Look at the cardiac borders and try to identify opacity

Answer 9

  opacity  Loss of lung markings  No shift

Answer 10

 Air in pleural space and lung collapses  Visible by areas with no lung markings  Denser surrounding lung  Shift in structures

Answer 11

 Visible fluid line  Changeable based on patient position  Shift of structures away from effusion  ↑ opacity  ‘meniscus’ fluid line

Answer 12

preoperative assessment and discharge planning

Answer 13

 Appointment time: 45 – 60 minutes  Review of PMH, DH, SH (and all relevant components of subjective Ax)  Review of risk factors (cardiac and respiratory), co-morbidities and metabolic tests  Review of lifestyle risk factors and advice around this: smoking, alcohol etc  Review of cardiopulmonary symptoms (if any)  ECG and/or echocardiogram  Pulmonary function test/spirometry/full pulmonary assessment  Exercise tolerance test/CPET  Neurological assessment  Other: liver, kidney, bladder screening, clotting disorders, allergies etc  Anaesthesia assessment  Done by anaesthetist (about 15 mins)  Test and evaluate suitable mode of anaesthetic, check for any allergies, discuss risks, provide any additional information/support  Provide patient leaflets, review date of admission, need for ambulance/transport, advice around fasting, expected timeline of Sx, Rx, recovery & discharge  Prior to admission some patients will attend a pre-operative clinic  Including patients on enhanced recovery programmes (ERP) – which may include planned CABG, planned general abdominal, orthopaedic and gynaecology surgery  At the pre-op stage pts will undergo Ax by the MDT, be given info about their care and discharge post-op  Pts are expected to play an active role in their recovery  Identify patients who are high risk for post-op respiratory complications  The aims of a pre-oeperative physio review are:  Understand the patient’s pre-operative mobility, functional level and social circumstances  ‘Make Every Contact Count’- lifestyle advice  Education/mental preparation for what to expect post op  Giving him ownership/control of his own recovery- psychological benefit  Empower the patients to be an active part in their post-op recovery  Teach ACBT  Teach bed exercises  Discuss expected mobility progress  Discuss participation in cardiac rehabilitation  If CABG – teach sternal precautions  (if ortho teach any related joint precautions, practice with walking aids e.g NWB, ?equipment for discharge)  Pre op exercise programmes

Answer 14

 Evidence based approach to enhancing recovery post elective surgery  Aims to reduce stress to body during surgery, increase patient participation in recovery, and reduce length of stay  Involves a pathway including: - Preoperative assessment, planning and preparation - Reducing the physical stress of the operation - Structured approach to post op care/management - Early mobilisation Evidence based examples:  Meta-analysis of ERAS colorectal surgery: The length of hospital stay −2.55 (−3.24, −1.85)and complication rates [relative risk: 0.53 (0.44, 0.64)were significantly reduced in the enhanced recovery group (Varadhan et al., 2010).  Systematic review of ERAS for spinal surgery: Improved pain, reduced opiods post op. Cost savings. (Dietz et al., 2019)  Systematic review of ERAS liver surgery: LOS was reduced by 2.22 days in ERAS group compared to the standard care group. Fewer patients in ERAS group experienced complications (RR, 0.71). Hospital cost was significantly lower in the ERAS group. (Noba et al., 2020)

Answer 15

 Pain controlled?  Obs stable?  Aware of further exercises/precautions/advice?  Home set up/support  Mobile  Level of function needed ?mobility ?stairs ?ADLs  Follow up arranged e.g. cardiac rehab  MDT approach

Week 7 (parts 1 and 2) Flashcards

(39 cards)