drD's Anatomy-indications contraindications
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| D’amato Scopy |
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| Routine laryngoscopy is used when? | chronic cough, dysphonia, chronic throat pain, dysphaphia, voice changes, aspiration symptoms
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| Urgent laryngoscopy is used when? | difficult airway, angioedema, epitaxis, cervicofacial trauma, stridor, suspected foreign body
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| High risk pts who should be laryngoscopied | pt w/ear pain, hoarseness, sore throat (particularly when >2wks)
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| Laryngoscopy must be performed with care in which pts? | epiglottitis
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| Direct laryngoscopy is used when? | intubation and anesthesia; voice problems; Ear/Throat pain; swallowing issues; airway obst.
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| Complications of l.scopy | vocal cord or laryngeal damage (arytenoids dislocation), damage to teeth, bleeding, infection
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| Dx uses for bronchscopy | persistent/unexplained cough; blood in sputum, abnormal chest x-ray; possible lung infection
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| Tx used of bronchoscopy | foreign body removal, stenting of collapsed airway; mass or growth-used for removal if blocking airway
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| Limitations of laryngoscopy? | Can’t see: laryngeal ventricle; piriform sinus apex; Retrocricoid mucosa; subglottic anatomies
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| What do you use if laryngoscopy isn’t cutting it? | bronchoscopy (done in OR)
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| Dr. D intubation |
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| Describe the 2ndary bronchial divisions | R and L; R superior/middle/inferior lobar bronchus; L sup/inf lobar bronchi
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| Describe the secondary bronchi | B1-3 sup. lobe; B4-5 middle lobe/lingual; B6-B10 inf. lobe
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| Annular ligaments | intercartilaginous lig. of trachea (btw tracheal rings)
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| What’s imp about R/L main stem bronchi angle? | R angle is more vertical& larger diameter so aspirated objects go R more commonly
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| Boundaries of mediastinum? | Sup: thoracic inlet->Angle of Ludwig (T4-5);Inf: Post->T11; Ant; T9; Middle: cardiac
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| When to intubate? | respiratory mechanics fail (flail chest, rib fx); Glasgow coma score <8; depressed mental status ; laryngeal edema, can’t protect airway, pts’ own respiration isn’t working
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| Types of intubation | orotracheal, nasotracheal, cricothyroidotomy; tracheostomy
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| Dis/advantages orotracheal intub. | easiest, larger tubes can be used; avoid sinusitis/nare injury ; but pt must be sedated
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| Dis/advantages nasotracheal | sedation not needed; don’t have to move pt; but sinusitis and nare damage can occur
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| Disadv. Cricothyroidotomy | complications: esophageal perforation; bleeding/hemorrhage; subcutaneous emphysema
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| Contraindications to cricothyroidotomy | didn’t attempt oro/naso; massive trauma to larynx/trachea
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| Indications to cricothyroidotomy | oro/naso failed; facial trauma; too much blood in nose/mouth; airway blcked; pt anatomy hard
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| Needle cricothyroidotomy is used when? | kids airway obstruction; temporary-adults till can get them to OR for cric/trach
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| Tracheostomy advantages | lower pressure; no larynx/vocal cord damage; nursing care simpler; extubation less serious; suction more direct; good when vent weaning is slow
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| Tracheostomy disadvantages | tracheal necrosis risk; infection risk; can’t reposition as easily; seal not as good as translaryngeal cuffs
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| Convert from translaryngeal to tracheostomy when? | 3 days to months depending on if long term intubation is planned
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| What’s the dif. Dx for coin lesions? | infection, cancer, inflammatory nodules, congenital anomalies, benign growths
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| What determinates make one think malignant lung? | large, rapidly growing, smoker, speculated, non calcified
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| What determinates make one think benign lung? | small (<1cm, calcified, +skin test
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| What tools are used to dx lung cancer? | bronchoscopy, fine needle aspiration cytology, chest xray, sputumcytology, Mediastinoscopy, PET scan
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| What is Pulmonary TB? | mycobacterium tuber.; necrotizing pneumonia which can necrotizes hilar nodes
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| Pulmonary TB tx? | RIPE rifampin; isoniazid; pyrazinamide; ethambutol
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| Empyema | collection of pus between lung and chest wall
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| When to do surgery? | empyema; hematosis regularly; >5 mo duration post tx; lung mass infected with TB; drug resistanc
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| Bronchiectasis | dialation of bronchi (usually distally) often caused by infection; presents with chronic, bloody cough
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| Benign lung tumors are which? | harmatoma; lipoma; granuloma; fibroma; sclerosing hemangiona; hemangiopericytoma
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| What is the most common lung cancer? | non-small cell adenocarcinoma: presents typically as non-operable disseminated 2/3
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| How much does chemo and rad inc survival chances with use of sx? | 5-15%
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| Most common chest wall tumors | chondrosarcoma; plasmacytoma; fibrosarcoma; ewing’s sarcoma, osteosarcoma
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| What is exudative pleural effusions significant of? | malignant process
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| Spontaneous pneumothorax | bleb in upper lobe ruptures; pleuritic chest pain, tall thin males most common, reoccurs
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| Thymomas most common where? | anterior mediastinum
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| Neurogenic tumors (neurofibroma and neuroblastoma) most common where? | posterior mediastinum
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