thoracic surgery n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Thoracic Surgery PowerPoint Presentation
Download Presentation
Thoracic Surgery

Loading in 2 Seconds...

play fullscreen
1 / 54

Thoracic Surgery - PowerPoint PPT Presentation


  • 214 Views
  • Uploaded on

Thoracic Surgery. By Mike Poullis. Overview. What is it ? What do you need to know as a nurse on the ward ?. What do you need to know as a nurse on the ward ?. Different pathologies Different operations Chest drains Post operative care. Different pathologies. Lung cancer Pneumothorax

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Thoracic Surgery' - guillaume


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
thoracic surgery

Thoracic Surgery

By

Mike Poullis

overview
Overview
  • What is it ?
  • What do you need to know as a nurse on the ward ?
what do you need to know as a nurse on the ward
What do you need to know as a nurse on the ward ?
  • Different pathologies
  • Different operations
  • Chest drains
  • Post operative care
different pathologies
Different pathologies
  • Lung cancer
  • Pneumothorax
  • Pleural effusions
  • Lung biopsies
  • Trauma
  • Oddities
different operations
Different operations
  • Bronchoscopy (oesophagoscopy)
  • Mediasteinoscopy
  • Mediasteinotomy / Chamberlains
  • Thoracoscopy VATS
  • Mini thoracotomy
  • Full thoracotomy
  • Pneumonectomy / Lobectomy / Wedge
anatomy
Anatomy
  • Trachea
  • 2 bronchi
  • 2 Lungs
  • 2 lobes on left
  • 3 lobes on right
lung cancer
Lung cancer
  • Small cell
  • Non small cell
    • Squamous
    • Adeno
    • Large cell
    • Undifferentiated
lung cancer1
Lung cancer
  • Except for small cell carcinoma of the lung it is generally accepted that surgery is the most effective therapy for lung carcinoma
assessment of patient
Assessment of Patient
  • Fitness for surgery
  • Operability of the tumour - Staging
staging
Staging
  • TNM
  • T size and position of tumour
  • N lymph node status
  • M metastasis
stages
Stages
  • Stage Grouping—TNM Subsets
  • Stage 0 (TisN0M0)
  • Stage IA (T1N0M0)
  • Stage IB (T2N0M0)
  • Stage IIA (T1N1M0)
  • Stage IIB (T2N1M0, T3N0M0)
  • Stage IIIA (T3N1M0), (T(1–3)N2M0)
  • Stage IIIB (T4, Any N, M0) (Any T, N3M0)
  • Stage IV (Any T, Any N, M1)
fitness for surgery
Fitness for Surgery
  • Age
  • Pulmonary function
  • Cardiovascular function
  • Medical conditions
  • Nutritional Status
  • Performance status
assessment of operability
Assessment of Operability
  • CT scan
  • Bone scan
  • PET scan
  • Mediastinoscopy
  • Anterior Mediastinotomy
  • VATS
pleural effusions
Pleural effusions
  • Fluid in chest
  • Due to underlying cause
  • Usually malignant, but what ?
  • Drain for
    • Symptoms
    • Diagnosis
pneumothorax
Pneumothorax
  • What is a pneumothorax ?
  • How do you treat them ?
  • Who requires surgery ?
  • What does surgery entail ?
    • Thoracotomy
    • Sternotomy
    • Mini thoracotomy
    • VATS
lung biopsies
Lung biopsies
  • Need tissue to diagnose “Interstitial lung disease”
slide34

Thoracotomy

Posterolateral

Lateral

Anterolateral

Mini thoracotomy

mini thoracotomy
Mini thoracotomy
  • Small incision thoracotomy
lung resection
Lung Resection
  • Pneumonectomy
  • Lobectomy
  • Wedge
slide39

Lung Resection – Pneumonectomy

Intrapericardial

Extrapericardial

No reserve

Sputum

pO2

Fluid balance

Infiltrates

Temperature

AF

slide40

Lung Resection – Lobectomy

3 Lobes on RT

RUL

RML

RLL

(not RUL & RLL)

2 lobes on LT

LUL

LLL

chest drains
Chest drains
  • What are they ?
  • Why use them ?
  • Suction and its role
  • What drain do you take out MARK IT
function
Function
  • Conduit to remove fluid or air from the pleural or pericardial spaces
  • The fluid may be blood, pus or pleural effusion
  • Allow the lungs and heart to work unrestricted
spaces that need draining following thoracic surgery
Spaces That Need Draining Following Thoracic Surgery
  • Only a single pleural cavity opened
  • Air and blood may collect in the space
  • Two drains
    • Apical drain – Air
    • Basal drain – Blood
  • Traditionally apical drain is placed anteriorly and basal drain at the back
suction
Suction
  • What does it do?
    • Makes the external pressure negative
  • Air or blood drains more easily out of chest

Dangers

  • If on to high tissues may get sucked into the drain damaging them
  • If connected but not on similar effect to clamping the drains
  • BEWARE PNEUMONECTOMY
does and don ts of chest drains
Does and Don’ts of Chest Drains
  • Do not clamp a functioning drain as this can lead to a tamponade or a tension pneumothorax
  • If becomes disconnected, reconnect and ask patient to cough
  • Always keep drain below level of patient
    • If raised above patient the contents may siphon back into the chest
on expiration
On Expiration
  • Pleural pressures at their highest
    • But still less than atmospheric pressure
  • Difficult to hold breath at full expiration
  • Natural reaction to pain is to take a deep breath in
on inspiration
On Inspiration
  • Easy to hold breath on maximal inspiration
  • Pleural pressure most negative therefore air more likely to move into pleural space
valsalva manoeuvre
Valsalva Manoeuvre
  • Forced expiration against a closed glottis
  • Creates a positive intrapleural pressure
  • Easy for patient to hold
post operative care
Post operative care
  • Blood pressure
  • Blood gases / saturation
  • Urine output
  • Bleeding
  • Sputum
  • Analgesia