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    Emergancies in Cardiothoracic Surgery

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    Jaser Yamin

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    Emergancies in Cardiothoracic Surgery

    Uploaded by

    Jaser Yamin
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    emergancies-in-cardiothoracic-surgery

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    3 views40 pages

    Emergancies in Cardiothoracic Surgery

    Uploaded by

    Jaser Yamin

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 40

    Emergencies in Cardiothoracic

    surgery
    Dr Al Ahmad M.R
    Asst.profossor
    Cardiothoracic Surgery Departmant
    generality
    • Anatomy of thorax
    • What is the most commun accedentes ?
    • How to see patients with cardiothoracic
    accedents ?
    • What investigations and why ?
    • Thoracic emergencies
    • Cardiac emergencies
    • others
    Anatomy of thorax
    Anatomy of thorax
    Anatomy of thorax
    Anatomy of heart
    What is the most commun accedentes?

    • gunshot injuries
    • White arms injuries
    • Cars accedents
    • Medecial accedents
    • Age accedent
    • others
    How to see patients with cardiothoracic accedents ?

    cardiothoracic emergencies may require


    surgical intervention within minutes or seconds.
    In general, cardiothoracic emergencies are
    precipitated by one of the following conditions:
    intractable myocardial ischemia, obstruction of
    forward cardiac output, hemorrhage, or
    obstruction to airflow. Each can kill within
    minutes.
    What investigations and why ?

    • Blood test
    • Hemostasis test
    • Blood group
    • CXR
    • ECHO cardiac and thoracic
    • CT scan – Angio scan
    Thoracic emergencies

    1. Pneumothorax
    2. Hemorrhage intra and extra airwaies
    3. Immersion and hypothermia
    4. Chest trauma
    Pneumothorax

    • accumulation of air within the pleural (potential) space.


    Pneumothorax often is categorized as small (less than 20% of
    pleural space volume), moderate (20% to 50%), or major
    (greater than 50% of pleural space occupied by air)

    • Etiology : iatrogenic puncture of the lung; alveolar rupture,


    particularly if underlying disease (blebs or emphysema); chest
    trauma,others,
    Signs and symptoms
    • The classic triad of hypoxemia, hypotension,
    and wheezing
    • Hypotension, hypoxia, high inflation
    pressures, and the clinical findings of right
    heart failure and shock
    • Clinical examination : listen and touch
    Radiology
    • CXR

    •
    CT Scan
    Management
    Hemorrhage intra and extra airways

    • blood is coming from the respiratory tract and not from the
    nasopharynx or gastrointestinal tract.
    • Massive hemoptysis (greater than 600 mL/24 hours)
    • Coughing up blood is a universally terrifying experience for
    patients. Physicians, too, should recognize that "conservative"
    treatment of massive hemoptysis is associated with 75%
    mortality. The incidence of rebleeding is high (80%), so
    decisions about definitive treatment should be made early.
    radiology
    • CXR
    • CT Scan / angio scan
    Management
    • Medical : - ADRE
    - sandostatine

    • Surgery : -invasive radiology


    - lobectomy
    - pneumonectomy
    Immersion and Hypothermia

    • Drowning is the second leading cause of accidental death


    among children next to motor vehicle accidents.

    • The common problem in drowning is aspiration. Fluid


    aspirated by the drowning victim frequently is a mixture of
    stomach contents and drowning medium.

    • Loss of surfactant, alveolitis, pulmonary edema, and


    ventilation–perfusion mismatching are present. The lungs are
    at great risk for infection.
    Cardiac emergency
    • Attention : time is gold
    • Do what you think it’s right…
    • Anatomy :
    Tamponade
    • How fast ?
    • How much ?
    • Cardiac tamponade is most commonly related to one of three causes:
    trauma
    infection
    neoplastic disease.
    Other possible causes include the following:

    -Acute myocardial infarction


    -Postoperative bleeding (cardiac patients have a 3% to 6% incidence of tamponade). Common
    sources of bleeding are graft suture lines, arterial bleeding from the sternum, and generalized
    coagulopathy
    -Aortic dissection with intracardiac leak or rupture
    -Iatrogenic (central venous catheter placement, radiation, pacemaker, cardiac catheterization)
    -Connective tissue disorders
    -Uremia
    • Beck triad: a small quiet heart, increased
    venous pressure, and hypotension

    • Cardiac Echo : -more than 2 cm on the RA


    - septum paradoxal
    Treatment
    ponction surgery
    Massive pulmonary embolism
    • Right heart thrombus
    • Time is life
    • The classic triad of dyspnea, pain, and
    hemoptysis is present in fewer than 25% of
    patients
    Angioscan
    Emergency coronary artery bypass surgery
    • Surgical revascularization often is indicated for life-
    threatening clinical situations, such as cardiogenic shock,
    severe mitral valve regurgitation, repair of post infarction
    ventricular septal defects, and unstable angina that does not
    respond to medical therapy.
    • Myocardial revascularization performed during an acute
    myocardial infarction has a higher mortality rate. Surgery
    during an acute myocardial infarction with necrosis results in
    ventricular arrhythmias, greater postoperative use of
    inotropic drugs, and an increased need for an intraaortic
    balloon pump.
    Treatment
    Aortic Dissection
    Types
    Treatment
    Infective Endocardites
    Chest Trauma

    Blunt trauma to the chest:


    Cardiac injuries:
    A. Transection or dissection of the thoracic aorta
    B. Cardiac tamponade
    C. Myocardial contusion
    D. Laceration of a coronary artery
    E. Laceration of the pericardium, papillary muscles, valves or intraventricular septum

    Noncardiac injuries :

    A. Tension pneumothorax/open pneumothorax


    B. Rib fractures and flail chest
    C. Pulmonary contusion
    D. Diaphragmatic rupture
    E. Tracheobronchial disruption
    F.Esophageal disruption
    Penetrating trauma to the chest:
    • The injuries produced by a knife.
    • Gunshot wounds, however, are considerably
    different. The "zone of injury" produced by
    high-velocity bullets extends far beyond the
    tract between entry and exit points.
    • Explosive forces, shearing forces, and
    cavitation all combine to produce complex
    injuries.

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