alveoli
The terminal end of the bronchioles where gas exchange occurs
aneurysm
A sac formed by localized dilation of the walls of an artery due to structural weakening
arrhythmia
Absence of cardiac rhythm
atria
upper chambers of the heart
cardiac cycle
Everything that occurs within the heart during a single heart beat
ductus arteriosus
A fetal blood vessel that joins the aorta and pulmonary artery
hyaline cartilage
elastic cartilage found on the ends of bones, trachea, ribs, and calcifies as the individual ages
infarction
An area of dead tissue caused by an inadequate supply of oxygenated blood
infiltrate
Accumulation or diffusion of foreign substance into tissue
mediastinum
The area in the thoracic cavity between the lungs
myocardium
heart muscle
oxygenated
saturated with oxygen
pericardium
A thin serous sac that surrounds the heart
pleura
A thin serous membrane that encloses the lung
prolapse
To fall or slip out of normal anatomical position
regurgitation
backward flow of fluid in the opposite of normal direction
stent
Device inserted to support luminous structures while still allowing passage of fluid
systole
contraction phase of cardiac cycle
tachycardia
Fast heart rate-greater than 100bpm
bradycardia
Slow heart rate-less than 60bpm
tamponade
compression of an anatomical part
ventricles
the lower chambers of hte heart that receive blood from the atria
Diagnostic procedures used for the thoracic cavity:
X-ray, CT Scan, MRI, Pulmonary angiography
What procedures are used for the evaluation of cardiac disease
electrocardiography, echocardiography, cardiac catheterization
ECGor EKG
electrocardiography
Electrocardiograph
A device used to record the electrical activity of the heart
Echocardiography
provides a two dimensional image of the heart by directing beams of ultrasonic waves through the chest wall
cardiac catheterization
permits the evaltuation of heart function, visualization of coronary arteries and cardiac chambers (especially the left ventricle) and measurement of pressures within cardiac chambers
What additional monitoring is required for cardiothoracic procedures?
a SWANZ-GANZ catheter for pulmonary wednge pressure and central venous pressure readings
an ARTERIAL CATHETER for the monitoring of ABGs
ELECTROCARDIOGRAPHY
AND
oxygen saturation temperature, and blood pressure equipment
What is used to detect a pulmonary embolism?
pulmonary angiography
Pulmonary artery
Carries deoxigenated blood to lungs
Right lung
Three lobes
Alveoli
Functional unit of respiratory system--exchanges O2 and CO2
Carina
Landmark for ETT tube placement--bifurcation of bronchi
Trache
C-shaped cartilage rings
Diaphragm
Muscle of respiration--phrenic nerve
Parietal pleura
Lines cavity-filled with fluid to prevent friction
True rib
Seven
Phrenic
Damage to this can cause diaphragmatic paralysis
Pulmonary vein
Carries oxygenated blood to atrium
Left Lung
Two lobes
Hilum
Concave medial side of each lung
Manubrium
Sternum
False Ribs
Five attached and floating
When is rigid bronchoscopy preferred?
performed for the removal of foreign objects in children, may occasionally be used for biopsy of a large central mass or for evaluating hemoptysis
What is the surgical technologist's responsibility during a flexible bronchoscopy?
using a 22-guage needle or letting the surgeon "tap" the specimen onto the telfa pad
What must be done when the bronchial brush is used?
Rub brush on microscope slide, use wire-cutting scissors to cut the brush off and hand to the circulator (in specimen cup)
Mediastinoscopy
performed for the evaluation of nodal involvement or mediastinal masses in pations with lung carcinoma
VATS
Video-Assisted Thoracic Surgery
CVP
...
ABG
...
Thorascopy vs. Laparoscopy
The thorax cannot be insufflated for expansion. Double lumen endotracheal tubes allow single-lung ventilation and collapse of the lung on the aeffected side
pectus excavatum
Congenital deformity that affects 4-5 ribs on each side of the sternum. A pectus bar is implanted
Extreme case of excavatum
the sternum may reach the vertebral column. A pectus bar is implanted
What will be used to bend the pectus bar?
A plate bender
Arteriotomy
an incision in the pulmonary artery with an #11 blade and extended with potts-smith scissors
What can be used to find plaque if needed?
a choledochoscope
empyema
blood or pus from a chest injury
how is empyema treated?
by decortation of the lung
decortication of lung
removal of the surface layer, membrane, or fibrous cover of the lung
usually performed when the lung is covered by a thick, inelastic pleural peel restricting lung expansion.
When lung is incised, how is the anastomosis checked for leaks?
Irrigation to look for bubbles
lobectomy
removal of a pneumonic lobe
pneumonectomy
removal of an entire lung
Chest tube
restores negative pressure of the chest
secured to the skin with a 2-0 silk suture
CPB
cardiopulmonary bypass
where are the primary cannulae placed?
in the right atrium or venae cavae for draining venous blood to the pupm oxygenator
How can a rubber catheter tourniquet be made?
with a red robbin catheter
atherosclerosis
Hardening of the arteries
What leads to myocardial infarction?
sudden occlusion of a narrowed vessel
MI
myocardial infarction
What can MI lead to?
coronary artery lesions, elevated tempurature and increased white cell count due to myocardial necrosis
myocardial necrosis
death of myocardial tissue
What is a cardiac tamponade?
blood escapes from the ventricle into the pericardial sac, the heart is compressed, interrupting normal rhythm.
cardiac tamponade
potentially lethal condition and is usually treated by pericardiocentesis
prolene suture
wet the surgeon's hands to prevent breaking them
CABG
Coronary Artery Bypass Graft[ing]
which vessels are used for the allograft in CABG?
Saphenous vein, and internal mammary artery, brachial and radial vein
What is the difference between a sternotomy and a repeat sternotomy?
on a repeat sternotomy, an oscillating saw is used so that a ventricle that may be adhered to the chest wall is not cut.
Why are the vessels irrigated with heparin?
to identify any branches that may have been missed, vessels are stored in heparinized saline until needed
Which anastomosis is made first?
distal
CABG procedure:
CPB machine required, 7-10 day hospitalization, 6-10 week full-length recovery
MID-CAB:
No CPB Machine, 4-6 day hospital, 2-4 week full-length recovery
OPCAB:
No CPB, 6-10 day hospital, 4-6 week recovery
Adenosine
a metabolite used to treat arrhythmias
Esmolol
a beta-receptor antagonist
VAD
Ventricular Assist Devices
cardiomyopathy
primary disease of the myocardium
types of cardiomyopathy
Alcoholic
Congestive
Hypertrophic
Infiltrative
Restrictive
classifications of aneurysm
true and false
what is used to repair a ventricular aneurysm defect?
A Dacron Fabric Patch
What are the most common causes of aortic valvular disease?
Age, Rheumatic fever
What can occur due to stenotic valves?
regurgitation
What are the causes of mitral regurtitation
stenosis or obstruction
two types of prosthetic valves
biologic tissue and mechanical
how is the tissue prosthesis prepared for use?
must be rinsed with saline according to protocol
Mitral valve commissurotom
surgical procedure to repair mitral valve
AVR
Aortic valve repair
Coarctation of the aorta
localized narrowing of the aorta in an otherwise normal vessel
most common cyanotic heart defect in children
Tetralogy of Fallot
cyanosis
blue baby syndrome
tetralogy of fallot
VSD, Infundibular pulmonary valve stenosis, aorta overrides VSD, and right ventricular hypertrophy are characteristics
VSD
Ventricular Septal Defect
ASD
Atrial Septal Defect
Contents of mediastinum:
heart, venae cavae, aorta, pulmonary trunks, pulmonary arteries, thymus, phrenic nerve, reccurrent laryngeal nerve, lymph nodes
flexible bronchoscope
inserted through the patient's nose
Pulmonary Thromboendarterectomy
removal of blood clot within the pulmonary arteries inside the lung
pulmonary hypertension
high blood pressure in the lungs
position for upper lobectomy/pneumonectomy
posterolateral
diastole
when the heart refills with blood after systole
lubb
closing of AV valves
dubb
closing of semilunar
OPCAB
Off Pump Coronary Artery Bypass
MIDCAB
Minimally Invasive Direct Coronary Artery Bypass
IABP
Intra-Aortic Balloon Pump
repair of coarctation of the aorta
EEA, or subclavian flap.
If a knitted graph is preclotted, it
Minimizes bleeding
The term used to denote the function accomplished by the cardiopulmonary bypass machine is
perfusion
The antagonist to heparin sodium is
protamine sulfate
Pedal pulses are assessed with a
Doppler
Heparin is utilized during vascular surgery
to prevent thrombosis
The prime consideration in a ruptured abdominal aortic aneurysmectomy is
hemorrhage control
In which surgery would a tunneler be used?
Femoral-popliteal bypass
In a balloon anbioplasty, the dilating balloon is inflated with
diluted solution of contrast media
Which piece of equipment would be placed on an embolectomy setup for the purpose of removing clots through an arteriotomy?
Fogarty
The goal of carotid endarterectomy is to
remove plaque
Decompression of the portal circulation can be achieved by all of the following EXCEPT
Arteriovenous shunt
Plaque removal from a vessel is termed
endarterectomy
Placement of a vascular graft proximal to and inclusive of the common iliac vessels will necessitate the use of a/an
bifurcated graft
The most common vessel used for access procedures to facilitate hemodialysis are
radial artery and cephalic vein
Migrating clots that have formed in the lower extremities can be intercepted on the way to the heart or lungs by a
Greenfield Filter
Retraction of fine structures and blood vessels during vascular surgery is accomplished by use of
vessel loops
Fluoroscopy is required for all of the following vascular procedures EXCEPT
AV arteriovenous fistula creation
A drug used intraoperatively for its antispasmodic effect on the smooth muscle of the vessel wall is
papaverine hydrochloride
Compression of subclavian vessels and brachial plexus at the superior aperture of the thorax is known as
thoracic outlet syndrom
In vascular surgery, the term in situ graft references the use of a/an
autogenous graft
The surgery scheduled as Greenfield filter insertion indicates a diagnosis of
emboli formation
During a vascular procedure, monitoring the activated clotting time intraoperatively provides useful data for judging the need for reversal or addition of
heparin
A low-molecularpweight protein that, when combined with heparin, causes a loss of anti-coagulant activity postoperatively is
protamine sulfate
What is the purpose for the surgical creation of an arteriovenous fistula?
Hemodialysis
Conservative treatment of occlusive disease involving recanalization to restore the lumen of a vessel is called
Percutaneous Transluminal Angioplasty (PTA)
What procedure is used intraoperatively and postoperatively to determine blood flow in a vessel
Doppler ultrasound
Removal of atherosclerotic plaque from a major artery is termed
endarterectomy
An abnormal localized dilation of an artery resulting from mechanical pressure of blood on a weakened wall is called
aneurysm
What is the treatment of choice for capturing emboli that arise from the pelvis or lower extremities?
Greenfield filter
What intraoperative test determines the needed reversal or addition of heparin?
Activated clotting time (ACT)
What drug is used intraoperatively in a topical manner for its direct effect on the muscle of the vessel wall?
Papaverine hydrochloride
The technique applied to the patient who is able to be weaned from cardiopulmonary bypass is
IAPB and VADs
What is the m ost common acquired valvular lesion?
Mitral stenosis
What drug is used to effect coronary thrombolysis in the cardiac catheterization laboratory?
Tissue plasminogen activator and Streptokinase
The term in situ graft represents the use of a/an
autograft
The buildup of fat residue on a vessel wall is
atherosclerosis
The self-retaining retractor used when performing a fem-pop bypass is
Weitlaner
Chronic cerebral ischemia most often leads to
carotid endarterectomy
AAAs commonly occur
below the renal arteries
Occluding peripheral vessels is achieved with the use of
bulldog
When performing an anteriotomy, the surgeon will require a #11 blade and
Potts Smith scissor
Removal of plaque during a carotid endarterectomy requires
Freer Elevator
Electrical impulses that stimulate the heart muscle is achieved with
pacemaker
Fibrillation is described as
involutary muscle contraction
The cardiac pulse when the ventricles contract is
systole
Bradycardia is defined as ________________ beats per minute
40-60
The most commonly used incision for surgical procedures of the heart is
Median sternotomy
The aortic valve maintains one way blood flow to the aorta from the
left ventricle
The only arteries int he body that carry deoxygenated blood to the lungs are
pulmonary
During dialysis the patients blood is shunted to the outside of the body. The term referring to outside of the body is
extracorporeal
Which of the following is the correct order from outermost to innermost layers of the blood vessels:
1. tunical adventia
2. tunica media
3. tunica intima
1, 2, 3
A Javid shunt is used during a
carotid endarterectomy
The relaxation phase of the cardiac cycle is
diastole
A percipitous drop in the patients blood or fluid volume is
hypovolemia
The procedure that is performed for dialysis that produces a direct anastamosis between an artery and a vein is
AV fistula
When performing a femoral-femoral bypass, the atherosclerotic disease is in the
iliac artery
The tube that collects bronchial washings is
Lukens
What instrument is used to view lymph nodes or masses int he space that medially separates the pleural cavities?
Mediastinoscope
The procedure of choice for removal of a foreign body in a child's tracheobroncial tree is
bronchoscopy
A cytologic specimen collector used in bronchoscopy is
Lukens
All of the following are true regarding disposable chest drainage units EXCEPT
aids in reestablishing positive pressure in the intrapleural space
Compression of the subclavian vessels and the brachial plexis usually caused by the first rib is surgically known as
thoracic outlet syndrome
A reduction of negative pressure on one side of the thoracic cavity that causes the negative pressure on the normal side to pull in an effort to equalize pressure is called
mediastinal shift
Surgical removal of fibrinous deposits on the visceral and parietal pleura is called
decortation of the lung
What substance is introduced through a thoracoscope to deal with reccurrent pleural effusion attributable to adnvanced cancer
Talc
What instrument is used to reapproximate the ribs following an open thoracotomy?
Bailey
What cold solution is used to preserve a donor lung before transplant into a recipient?
Collin's
How many anastomoses must be completed to effect a single-lung transplant?
Three
What is the preferred solution used for bronchial washings?
Sterile saline
During the mechanical process of breathing the diaphragm contracts ______ and relaxes during ______
inhilation, exhalation
Biopsy of this node is performed before a thorocotomy to stage cancer or to confirm a diagnosis
scalene
The most important laboratory test done to measure pulmonary function is
ABGs
Which of the pulmonary function tests measures the amount of air exhaled during normal respiration?
Tidal volume
All of the following are TRUE regarding the rigid bronchoscope EXCEPT
patients who have difficulty hyperextending the neck and difficult jaw manipulation
A thymectomy is commonly performed for malignant tumors and
myasthenia gravis
What nerves are carefully preserved during a pneumonectomy?
Vacus, left recurrent laryngeal, and phrenic
When performing a thorocotomy, the wound edges are covered to protect them from bruising with what?
Moist lap pads or towels
The lung is divided into anatomical regions. The right lung has ___ lobes and the left lung has ____ lobes
Three and two
In which surgery would a closed drainage system be used
Thoroscope lung biopsy, Open thorocotomy, Lung volume reduction surgery
Bleeding arising from the respiratory tract is called
Hemoptysis
Positioning for a single lung transplant, the donor patient is ____ and the recipient patient is _____
supine, lateral