Chapter 22

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