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Cardiothoracic
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
This is a chest drain set (Figure 5.1). It has a selection of syringes and needles, a scalpel, a blade, sutures, a guidewire, a dilator, a chest tube and a closed drainage system. The chest drain is available in different sizes typically ranging from 8 Ch to 36 Ch. It can be inserted by thoracotomy or using the Seldinger technique with a guidewire. Although the British Thoracic Society (BTS) guidelines strongly recommend that this procedure should be done under ultrasound guidance, clear understanding of the anatomical landmarks is important. The preferred site of chest drain insertion is the safety triangle. This is defined as the space bordered superiorly by the base of the axilla, anteriorly by the lateral edge of the pectoralis major, inferiorly by the 5th intercostal space and laterally by the lateral edge of the latissimus dorsi muscle. The needle should be inserted just above a rib to avoid damage to the neurovascular bundle though the lower the rib is, the less likely it is that the rib flange will cover the bundle and as such, a more anterior site may avoid damage (Carney and Ravin, 1979; Havelock et al., 2010). The chest tube is secured at the skin using the sutures provided. The chest drain should be connected to a closed drainage system to prevent entrapping air or fluid into the pleural cavity. A wide range of systems can be used including the underwater seal, flutter valve or a multifunction chest drainage system.
Rehabilitation team
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Inês Machado Vaz, Sofia Viamonte, João Carlos Winck
There are several physiotherapy respiratory techniques for volume recruitment by single breath- or stacked breath-assisted inspiration. Mucus clearance may be facilitated using a peripheral airway clearance device such as a high-frequency chest wall oscillator, a flutter valve or positive expiratory pressure (8).
Gastroesophageal reflux in the neonate and small infant
Published in Prem Puri, Newborn Surgery, 2017
Briefly, the endoscope is introduced into the esophagus under visual control and is usually extended down to the duodenum. Biopsies from the duodenum and antrum of the stomach are taken routinely. The tip of the device is inverted in the stomach in order to inspect the gastroesophageal junction from below. Under normal circumstances, the esophagus encloses the device tightly, and the aforementioned flutter valve can be seen at the lateral circumference. In contrast, in a hiatus hernia, the cardia is slightly opened, and the investigator is able to see into the herniated stomach, whereas the LES encircles the device higher up.
Bilateral open pneumothorax resulting in a sucking chest wound
Published in Acta Chirurgica Belgica, 2018
Sami Karapolat, Alaaddin Buran, Atila Turkyilmaz
Open pneumothorax is a rarely seen subgroup of traumatic pneumothorax that primarily occurs due to penetrating injuries. It typically involves a chest wall defect that directly communicates with the parietal pleura. In these sucking chest wounds, even after the atmospheric and intra-pleural pressures have equalized, air will continue to flow along the path of least resistance [2]. If the defect diameter is 2/3 of the trachea diameter or larger, the injury causes ventilatory insufficiency and rapid respiratory decompensation; if it is seven times larger than the trachea diameter, death may occur at any time. In treatment, an urgent three-way occlusive dressing should be applied to the chest wall defect area to achieve a flutter-valve mechanism for ventilation maintenance; then an intercostal chest drain should be inserted through a separate incision. As soon as the patient achieves hemodynamic and respiratory stability, the wound should be explored and the chest wall defect should be repaired. Open pneumothorax is a potentially fatal condition. Early and correct diagnosis after a careful physical examination and adherence to the above treatment algorithm can prevent morbidity and mortality.
High power microwave ablation of normal swine lung: impact of duration of energy delivery on adverse event and heat sink effects
Published in International Journal of Hyperthermia, 2018
Hiroshi Kodama, Eisuke Ueshima, Song Gao, Sebastien Monette, Lee-Ronn Paluch, Kreg Howk, Joseph P. Erinjeri, Stephen B Solomon, Govindarajan Srimathveeravalli
The major treatment-related AE was intraprocedural pneumothorax requiring chest tube placement, which occurred in three of 10 animals (Table 1). Continuous air drainage with wall suction was necessary to maintain lung expansion in 2 animals, while the pneumothorax stabilised without suction in 1 animal. Pneumothorax in the latter animal was controlled using a flutter valve and was observed to resolve on CT imaging on day 2 post-ablation. Resource and experimental constraints did not permit continuous wall suction in two of three animals, and they were euthanized within four hours after MWA. Data acquired with these animals were included only for evaluation of intra-procedural AE.