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Thoracic Surgery

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

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Thoracic Surgery

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  1. Thoracic Surgery By Mike Poullis

  2. Overview • What is it ? • What do you need to know as a nurse on the ward ?

  3. What do you need to know as a nurse on the ward ? • Different pathologies • Different operations • Chest drains • Post operative care

  4. Different pathologies • Lung cancer • Pneumothorax • Pleural effusions • Lung biopsies • Trauma • Oddities

  5. Different operations • Bronchoscopy (oesophagoscopy) • Mediasteinoscopy • Mediasteinotomy / Chamberlains • Thoracoscopy VATS • Mini thoracotomy • Full thoracotomy • Pneumonectomy / Lobectomy / Wedge

  6. Anatomy • Trachea • 2 bronchi • 2 Lungs • 3 lobes on left • 2 lobes on right

  7. The Right Lung

  8. The Left Lung

  9. Bronchial system

  10. Lung cancer • Small cell • Non small cell • Squamous • Adeno • Large cell • Undifferentiated

  11. Lung cancer • Except for small cell carcinoma of the lung it is generally accepted that surgery is the most effective therapy for lung carcinoma

  12. Small Cell Lung Cancer

  13. Assessment of Patient • Fitness for surgery • Operability of the tumour - Staging

  14. Staging • TNM • T size and position of tumour • N lymph node status • M metastasis

  15. Stage IA of Lung Cancer

  16. Stage IB of Lung Cancer

  17. Stage IIA of Lung Cancer

  18. Stage IIB of Lung Cancer

  19. Stage IIIA of Lung Cancer

  20. Stage IIIB of Lung Cancer

  21. Stage IV of Lung Cancer IV: Any T, Any N, M1 Synchronous tumours in different lobes are M1

  22. Fitness for Surgery • Age • Pulmonary function • Cardiovascular function • Medical conditions • Nutritional Status • Performance status

  23. Assessment of Operability • CT scan • Bone scan • PET scan • Mediastinoscopy • Anterior Mediastinotomy • VATS

  24. Bronchoscopy

  25. oesophagoscopy

  26. Mediastinoscopy

  27. Mediastinotomy / Chamberlains

  28. Mediastinotomy

  29. Thoracoscopy

  30. Video Assisted Thoracic Surgery

  31. Thoracotomy

  32. Thoracotomy - Posterolateral

  33. Thoracotomy - Anterolateral

  34. Mini thoracotomy • Small incision thoracotomy

  35. Lung Resection • Pneumonectomy • Lobectomy • Wedge

  36. Lung Resection – Pneumonectomy

  37. Lung Resection – Lobectomy (RUL)

  38. Lung Resection – Lobectomy (RUL)

  39. Wedge resection

  40. Pleural effusions • Fluid in chest • Due to underlying cause • Usually malignant, but what ? • Drain for • Symptoms • Diagnosis

  41. Pneumothorax • What is a pneumothorax ? • How do you treat them ? • Who requires surgery ? • What does surgery entail ? • Thoracotomy • Sternotomy • Mini thoracotomy • VATS

  42. Lung biopsies • Need tissue to diagnose “Interstitial lung disease”

  43. Open lung biopsy

  44. Chest drains • What are they ? • Why use them ? • Suction and its role • What drain do you take out MARK IT

  45. Rocket bottle

  46. Cardiac drain system

  47. Post operative care • Blood pressure • Blood gases / saturation • Urine output • Bleeding • Sputum • Analgesia

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