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drD's Anatomy-indications contraindications

D’amato Scopy
Routine laryngoscopy is used when? chronic cough, dysphonia, chronic throat pain, dysphaphia, voice changes, aspiration symptoms
Urgent laryngoscopy is used when? difficult airway, angioedema, epitaxis, cervicofacial trauma, stridor, suspected foreign body
High risk pts who should be laryngoscopied pt w/ear pain, hoarseness, sore throat (particularly when >2wks)
Laryngoscopy must be performed with care in which pts? epiglottitis
Direct laryngoscopy is used when? intubation and anesthesia; voice problems; Ear/Throat pain; swallowing issues; airway obst.
Complications of l.scopy vocal cord or laryngeal damage (arytenoids dislocation), damage to teeth, bleeding, infection
Dx uses for bronchscopy persistent/unexplained cough; blood in sputum, abnormal chest x-ray; possible lung infection
Tx used of bronchoscopy foreign body removal, stenting of collapsed airway; mass or growth-used for removal if blocking airway
Limitations of laryngoscopy? Can’t see: laryngeal ventricle; piriform sinus apex; Retrocricoid mucosa; subglottic anatomies
What do you use if laryngoscopy isn’t cutting it? bronchoscopy (done in OR)
Dr. D intubation
Describe the 2ndary bronchial divisions R and L; R superior/middle/inferior lobar bronchus; L sup/inf lobar bronchi
Describe the secondary bronchi B1-3 sup. lobe; B4-5 middle lobe/lingual; B6-B10 inf. lobe
Annular ligaments intercartilaginous lig. of trachea (btw tracheal rings)
What’s imp about R/L main stem bronchi angle? R angle is more vertical& larger diameter so aspirated objects go R more commonly
Boundaries of mediastinum? Sup: thoracic inlet->Angle of Ludwig (T4-5);Inf: Post->T11; Ant; T9; Middle: cardiac
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
Types of intubation orotracheal, nasotracheal, cricothyroidotomy; tracheostomy
Dis/advantages orotracheal intub. easiest, larger tubes can be used; avoid sinusitis/nare injury ; but pt must be sedated
Dis/advantages nasotracheal sedation not needed; don’t have to move pt; but sinusitis and nare damage can occur
Disadv. Cricothyroidotomy complications: esophageal perforation; bleeding/hemorrhage; subcutaneous emphysema
Contraindications to cricothyroidotomy didn’t attempt oro/naso; massive trauma to larynx/trachea
Indications to cricothyroidotomy oro/naso failed; facial trauma; too much blood in nose/mouth; airway blcked; pt anatomy hard
Needle cricothyroidotomy is used when? kids airway obstruction; temporary-adults till can get them to OR for cric/trach
Tracheostomy advantages lower pressure; no larynx/vocal cord damage; nursing care simpler; extubation less serious; suction more direct; good when vent weaning is slow
Tracheostomy disadvantages tracheal necrosis risk; infection risk; can’t reposition as easily; seal not as good as translaryngeal cuffs
Convert from translaryngeal to tracheostomy when? 3 days to months depending on if long term intubation is planned
What’s the dif. Dx for coin lesions? infection, cancer, inflammatory nodules, congenital anomalies, benign growths
What determinates make one think malignant lung? large, rapidly growing, smoker, speculated, non calcified
What determinates make one think benign lung? small (<1cm, calcified, +skin test
What tools are used to dx lung cancer? bronchoscopy, fine needle aspiration cytology, chest xray, sputumcytology, Mediastinoscopy, PET scan
What is Pulmonary TB? mycobacterium tuber.; necrotizing pneumonia which can necrotizes hilar nodes
Pulmonary TB tx? RIPE rifampin; isoniazid; pyrazinamide; ethambutol
Empyema collection of pus between lung and chest wall
When to do surgery? empyema; hematosis regularly; >5 mo duration post tx; lung mass infected with TB; drug resistanc
Bronchiectasis dialation of bronchi (usually distally) often caused by infection; presents with chronic, bloody cough
Benign lung tumors are which? harmatoma; lipoma; granuloma; fibroma; sclerosing hemangiona; hemangiopericytoma
What is the most common lung cancer? non-small cell adenocarcinoma: presents typically as non-operable disseminated 2/3
How much does chemo and rad inc survival chances with use of sx? 5-15%
Most common chest wall tumors chondrosarcoma; plasmacytoma; fibrosarcoma; ewing’s sarcoma, osteosarcoma
What is exudative pleural effusions significant of? malignant process
Spontaneous pneumothorax bleb in upper lobe ruptures; pleuritic chest pain, tall thin males most common, reoccurs
Thymomas most common where? anterior mediastinum
Neurogenic tumors (neurofibroma and neuroblastoma) most common where? posterior mediastinum
Created by: VCOM2013