Thoracic Anatomy
Number of segments in the Left / Right lung?
Picture J
What are the 3 primary risks of subclavian line placement?
1. pneumothorax
2. hemothorax
3. infection
A
PTX
Name the Pressor that is best to give during a long esophagectomy case?
NONE!!!
Effort rupture of the esophagus
Boerhaave's Syndrome
Dark blood arising after biopsy during mediastinoscopy; 3 possible structures
SVC
Azygous
PA
Picture H
1. Absolute contraindication to removing a chest tube
2. Daily chest tube output needed for removal
1. Air leak
2. 200-300 mL per day
B
Anterior mediastinal mass
Thymoma, Teratoma, Lymphoma, Thyroid
What are the 5 causes of post-operative fever in order of usual time course?
1. Atelectasis
2. UTI
3. DVT
4. Infection
5. Drug reaction
The technique used to insert a pigtail catheter
Modified Seldinger technique
1. What are the layers of the esophagus
2. Airway structure most at risk during esophagectomy
1. mucosa, submucosa, circular / longitudinal muscle
2. Membranous portion of carina, Bronchus intermedius
Simple para-pneumonic effusion:
1. Size of drain
2. Medications that can be instilled into drain
1. 14Fr, or larger
2. Dornase 5mg, tPA 5-10mg -- twice daily
C
RML
1. Volume for Massive Hemoptysis definition
2. Three Etiologies
3. Treatment
1. 600 mL in 24 hours
2. Infection (Aspergillosis), Bronchiectasis, Tumor erosion, PA rupture, trauma
3. Affected side down, Intubation, DLT, Cold irrigation, Epinephrine injection, Angiography, Surgery
What are the 3 types of esophagectomy techniques?
Ivor Lewis, Transhiatal, McKeown
Nodes accessible from Mediastinoscopy
4R, 7, 4L
Picture I
This device (F) and what is its purpose?
DLT, lung isolation
D
Pneumomediastinum
1. Most common Arrhythmia associated with non-cardiac thoracic surgery.
2. Treatment
1. Atrial fibrillation, Atrial flutter
2. Amiodarone, BB, diltiazem, digoxin, cardioversion, EP ablation
This syndrome describes venous thoracic outlet obstruction
What is Pagett-Schroetter?
Describe course of the Thoracic Duct?
G
What is the diameter of a 24 Fr chest tube?
8mm
E
Sequestration
1. Milky-white effusion
2. What test / value is required for diagnosis
1. What is a chylothorax?
2. TG >110mg/dl
Crepitus in sync w/ heartbeat but not respiration
Hamman's Sign
(Oesophageal perforation w/ pneumomediastinum)