Cardio-Thoracic Surgery
Describe what a mediastinoscopy is, what is being viewed during one, and the symptoms that may lead to the performance of one.
-A mediastinoscopy is when access to the mediastinum is acquired through dissection through the suprasternal notch with the use of a mediastinoscope. -It is done in order to evaluate the degree of nodal involvement or mediastinal masses in patients with lung carcinoma. Some symptoms that may indicate a mediastinoscopy are cough, dispnea, and chest pain.
Name the three layers of the heart from INNER to OUTER
-Endocardium -Myocardium -Epicardium
List two approaches that can be used for insertion of a pacemaker lead
-Epicardial -Transvenous
The letters IMA stand for _____________________________. Why is its use during a CABG advantageous?
-Internal Mammary Artery -The benefits of using the IMA as a conduit is that it only requires one anastomosis and it is closer to the coronary arteries than the other conduits typically used.
What is the drug used to prevent spasm in a newly anastomosed vessel?
-Papaverine -Lidocaine 1%
Bronchoscopy
-Retrieve a biopsy from the lower respiratory tract -Used to remove a foreign body from the airway -Inserts a scope into the trachea -Can be either rigid or flexible
List two vessel conduits that can be used as a bypass graft during a CABG:
-Saphenous vein -Internal Mammary artery
Name the two Atrial-Ventricular valves of the heart.
-Tricuspid -Mitral (bicuspid)
Thoracoscopy
-Used to perform a lung biopsy -Uses a 10mm, 0 degree and 30 degree scope -Uses trocars and cannulas
Mediastinoscopy
-Uses a stainless steel endoscope inserted through a small incision at the suprasternal notch -Lymph node biopsy is performed routinely during this procedure
________________ procedures may be performed either open or as a video-assisted thoracotomy.
-lung biopsy -lobectomy -wedge resection
Disease of the heart valves can lead to two conditions that may require surgical intervention. Name them:
-regurgitation -stenosis
All of the following are true regarding disposable chest drainage units except:
Aids in reestablishing positive pressure in the intrapleural space
Which of the following best describes the function of the cardiopulmonary bypass machine?
Collects the patient's blood, removes excess carbon dioxide, oxygenates and warms the blood, and returns it to the patient's body
The surgical removal of the fibrin layer covering the visceral and pleura that prevents complete expansion of the lung is called ____________.
Decortication of the lung
T/F Hemothoarx is the presence of air in the thoracic cavity or between the pleural sac and lungs.
False
T/F Mediastinoscopy is an endoscopic examination of the thoracic cavity.
Fasle
Prior to cannulation for an open heart procedure, the drug that is administered to prevent clotting is _______________________.
Heparin
The conduction system of the heart causes the heart to beat. Explain how this occurs.
Impulses travel from the sinoatrial (SA) node to the AV node. From the AV node, conduction travels to the bundle of His, and then through the right and left bundle branches, ventricular walls, and Purkinje fibers.
An internal device used in patients who are susceptible to ventricular fibrillation or ventricular tachycardia is a/an _________________.
Internal implantable cardiac defibrillator
The coronary artery that is most commonly affected in a patient with CAD, and most dangerous for the patient is __________________________________.
Left Descending coronary artery.
The tube that collects bronchial washings is __________.
Lukens
A thymectomy is commonly performed for __________.
Myasthenia gravis
When patients are place in the lateral position, an axillary roll is positioned to ________.
Prevent pressure on the axillary nerves and blood vessels
________________ is used to reverse the effect of the drug given prior to cannulation in an open heart procedure that prevents clotting.
Protamine
A patient might need a lung volume reduction to ____________.
Remove a portion of a lung in which air is trapped in emphysematous lung tissue, improving the lung's function.
What structure is referred to as the "pacemaker" of the heart?
SA node
Which vessels are harvested for a CABG procedure?
Saphenous vein and internal mammary artery
The heart lies ____________.
Slightly to the left in the mediastinum
The Rummel tourniquet, commonly used in cardiovascular surgery, is a short length of rubber tubing either commercially prepared or cut from a ___________________.
Straight Robinson urinary catheter
Explain what the cardiac cycle is.
The cardiac cycle encompasses the cycle of blood pumping through the heart and the PQRST wave.
Trace the route of blood flow through the heart and lungs. Start with the structures where the blood enters the heart.
The deoxygenated blood first enters the heart through the superior vena cava, inferior vena cave, and coronary sinus into the right atrium. The blood then goes through the tricuspid valve into the right ventricle before going up through the pulmonary semilunar valve to the pulmonary arteries where it is taken to the lungs to be oxygenated and the C02 removed. The newly oxygenated blood is then taken up by the pulmonary veins and back to the heart to the left atrium and then down through the mitral valve into the left ventricle. The blood is then shot up from the left ventricle through the aortic semilunar valve and into the aorta where it is distributed through the three branches of the aorta (brachiocephalic, left common carotid, left subclavian) and the descending thoracic aorta to feed the body, and the coronary arteries to feed the heart.
In coarctation of the thoracic aorta, the heart becomes enlarged. This is due to ________.
The heart's burden of pumping blood through a stricture
Why would your surgeon wish to infuse cardioplegic solution into the coronary arteries during an open heart procedure?
The process protects the cardiac muscle from damage while the aorta is occluded and blood supply is interrupted
Name the two parts of the respiratory system and the body parts included in each.
The upper tract and the lower tract. -The upper tract includes the nose, nasal cavities, mouth, pharynx, and larynx. -The lower tract includes the trachea, brochi, bronchioles, and lungs.
Pain caused by compression of the blood vessels and the nerves within the brachial plexus in the space between your collarbone and first rib is known as:
Thoracic outlet syndrome
T/F Cardiac dysrhythmia is an abnormal pattern of conductivity in the heart.
True
The ___________ nerves are carefully preserved during pneumonectomy.
Vagus, left recurrent laryngeal, and phrenic
Manipulation of the heart during dissection may cause ____________.
Ventricle fibrillation
All of the following statements are false for thoracoscopy except?
Wedge resection of a lung can be achieved
Bradycardia is ___________.
a heart rate of 40-60
The coronary arteries rise from the ___________.
aorta
Which of the following procedures requires the use of cardiopulmonary bypass:
atrial septal defect
The sum of the blood cell and plasma volumes in the vascular system is the ________.
blood volume
Which of the following is not considered a sterile procedure?
bronchoscopy
All of the statements are false for aortic cannulation during cardiopulmonary bypass except:
cannula is placed in the aorta
During coronary artery bypass surgery, the surgeon occludes the ascending aorta and inserts the indwelling catheter for infusion of ____________ and venting of air.
cardioplegic solution
What structure is attached to the valvar cusps and prevents valve leaflets from swinging back into the atria?
chordae tendinae
Which of the following defines the term systole?
contraction phase
The ___________ is not a cardiac heart valve.
coronary
Coronary veins empty into the ______________.
coronary sinus
T/F An atrial conduit for a CABG procedure will not remain patent as long as a vein conduit.
false
T/F Cardiac defibrillating is used in patients who are susceptible to ventricular bradycardia.
false
During decortication of the lung, the incision is made into the _________ intercostal space.
fifth
Two classifications of aneurysms are saccular and ___________________.
fusiform
Following the anastomosis of a vein or an artery and before closure of the wound, hemostasis at the suture line may be maintained with a topical hemostatic agent such as __________.
gelfoam soaked in thrombin
The ______________ vein is commonly used as the vein graft for a CABG procedure.
greater saphenous
Which of the following protects the heart from damage during cardiopulmonary bypass?
hypothermia
A pacemaker is implanted to provide electrical stimulation to the heart to _________.
increase a slow heart rate
If the volume of red blood cells is higher than normal, the blood viscosity increases and the blood pressure _______________.
increases
Fibrillation is __________.
ineffectual quivering of the heart
Which mechanical device is designed for circulatory support after cardiac procedures?
intra-aortic balloon pump
An enclosed cavity in the chest containing the heart and large vessels, trachea, esophagus, and lymph nodes is the?
mediastinum
What age is your surgical patient who is undergoing a patent ductus arteriosus?
newborn
A device that produces electrical impulses that stimulate the heart muscle is ________.
pacemaker
What is the most common congenital chest deformity?
pectus excavatum
Pleural tumors are usually associated with _____________.
pleural effusion
What is the name of the area between the visceral and parietal pleura that contains serous fluid?
pleural space
The procedure that removes an entire lung to debulk (reduce the size) a malignant tumor and slow the spread of cancer is called ___________.
pneumonectomy
What is the medical term that refers to an abnormal accumulation of air in the pleural cavity?
pneumothorax
Which surgical patient position is used for lobectomy?
posterolateral
Which type of arrhythmia is characterized by contraction of a ventricle before it is expected in a normal series of cardiac cycles?
premature ventricular contraction
A patent ductus arteriosus is a persistent fetal communication between the ___________ and the descending thoracic aorta.
pulmonary artery
Into which portion of the heart is the cannula placed to achieve venous cannulation for cardiopulmonary bypass?
right atrium
Which portion of the heart received unoxygenated blood?
right atrium
Which chamber of the heart is responsible for pumping blood into the pulmonary artery?
right ventricle
When placing a permanent pacemaker and a right or left subclavian veinotomy is performed, the electrode is placed in the _____________.
right ventricular apex
During thoracotomy procedure, the shoulder muscles are retracted with a _______.
scapular retractor
Approximately 90% of all patients with lung cancer present with a history of _________.
smoking
Cardioplegia solution is used to ___________.
stop the heart's pumping action
Rheumatic carditis is typically proceeded by:
streptococcal throat infection
What substance is introduced through a thoracoscope to deal with recurrent pleural effusion?
talc
The major structures connected to the lung include all of the following except ________.
the aorta
The right lung is divided into how many lobes?
three
The valve between the right atrium and right ventricle is the ____________.
tricuspid
T/F An implantable ventricular assistive device is used for long-term support and utilizes a pump that is implanted into the patient's chest or abdomen.
true
T/F Chronic inflammation of the pericardium can produce a fibrotic coating over the heart that constricts the ventricles.
true
T/F Mitral valve disease is commonly caused by rheumatic heart disease.
true
An abnormal opening in the wall between the right and left ventricles of the heart is known as a/an ____________.
ventricular septal defect
Following a wedge resection, the surgeon inspects the suture line carefully for air leaks by filling the chest cavity with _______________ solution.
warm saline
Which solution or drug is not used on the patient during a coronary artery bypass procedure?
water
