[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]”This patient is under the care of respiratory outpatients on account of shortness of breath on exertion. Please examine their respiratory system and discuss your findings with the examiners.”[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191700″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station Time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][/vc_column][/vc_row]
0 of 3 questions completed
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading…
You must sign in or sign up to start the quiz.
0 of 3 questions answered correctly
Time has elapsed
You have reached 0 of 0 point(s), (0)
Earned Point(s): 0 of 0, (0)
0 Essay(s) Pending (Possible Point(s): 0)
- Not categorized 0%
This patient has a left thoracotomy scar and reduced expansion on the left hand side. He also has some crepitations around the thoracotomy site.
This is in keeping with a previous lobectomy. It is not possible to determine why the patient required a lobectomy from this video.
A thoracotomy is any surgery involving incisions into the pleural space. It is done in both emergency procedures as well as surgically planned procedures.
Thoracotomy procedures involve opening the chest cavity and will involve cutting through the ribs to expose a significant part of the chest to operate. The median sternotomy allows surgeons access to the anterior chest organs. The anterolateral thoracotomy is used in emergency cardiac massage for the management of a traumatic cardiac arrest. The posterolateral thoracotomy is used for the resection of posterior lobes, as well as access to the posterior organs such as the dorsal aorta for aortic stenosis or control of bleeding, and the oesophagus. The patient will often have to be under general anesthesia unless already unconscious, and will have to be put on a respirator
Indications and Contraindications
Emergency thoracotomies are best used in the cases of penetrating chest injuries or cardiac injuries. Thoracotomies are indicated for cases of traumatic internal hemorrhaging, cardiac tamponade, and other immediate problems resulting in hypoperfusion of the rest of the body (Sherren et al, 2013). It may also be used for internal cardiac massage and the prevention of air embolism.
For non-emergency chest procedures involving smaller lesions, such as excision of lung cancer, biopsy, pulmonary decortication, and other lung-related surgeries, consider using video-assisted thoracoscopic surgery (VATS) if the situation allows for it. VATS applications are increasing, and what may have only been possible with a thoracotomy may now be possible with VATS.
Pneumothorax is the most common post-operative problem of thoracotomy. Other possible problems are air leaks, infection, and bleeding. Respiratory failure can be due to severe dyspnea from the pain of breathing, or from the failure of oxygen perfusion of the blood in the lung. Atelectasis may also be present, as well as pneumonia, pulmonary embolism, pulmonary edema, and asthma attacks (Leo et al, 2006). Most complications arising from thoracotomy will be addressed by the surgeon’s experience.
Leo, F., Venissac, N., Pop, D., Anziani, M., Leon, M. E., and Mouroux, J. (2006). Anticipating pulmonary complications after thoracotomy: the FLAM Score. J Cardiothorac Surg. 2006; 1: 34. Published online 2006 Oct 6. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1609165/ on 08 Dec 2015.
Sherren, P. B., Reid, C., Habig, K., and Burns, B. J. (2013). Algorithm for the resuscitation of traumatic cardiac arrest patients in a physician-staffed helicopter emergency medical service. Crit Care. 2013; 17(2): 308. Published online 2013 Mar 12. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672499/ on 08 Dec 2015.
- Review / Skip
Question 1 of 3
On which side does the patient have reduced expansion?CorrectIncorrect
Question 2 of 3
What scar have you observed?CorrectIncorrect
Question 3 of 3
What procedure do you think this patient has had?CorrectIncorrect