week 10

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week 10
2012-04-08 22:21:26

chest trauma and lung cancer
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  1. Pulmonary Contusion
    Usually caused by rapid deceleration of motor vehicle. Hemorrhage occurs in and between the alveoli, decreasing lung movement and reduces the area for gas exchange. At first the Chest x-ray may show no abnormalities. May need mechanical ventilation with PEEP to inflate the lungs.
  2. Rib Fracture
    Drives the ribs inward, creating a risk for pulmonary contusion, pneumothorax and/or hemothorax. Splinting reduces breathing depth and leads to inadequate clearance of pulmonary sectretions. The more pain the patient has the less apt they are to deep breath. Analgesics that cause respiratory depression are avoided.
  3. Lung Cancer
    The overall 5 year survival rate for all patients with lung cancer is only 14%. Bronchogenic carcinomas: arising from the bronchial epitheliumParaneoplastic syndromes: Caused by hormones secreted by tumor cells, commonly occurs with Small cell lung cancer. Definition of lung cancer: Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.Staging based on T N M system (primary Tumor, regional lymph Nodes, distant Metastasis) higher numbers represent later stages and less chance for cure or long term survival.
  4. Lung Cancer (Cont’d)
    History: risk factors, such as smoking, work hazards, warning signs, any hoarsness, cough, sputum, hemoptysis, SOB, change in endurance. Assess for painPulmonary manifestations: chills, fever, breathing patterns, chest pain, abnormal retractions, accessory muscles, stridor, flared nostrils, dyspnea, wheezing, areas of tenderness or pain. Fremitis- increased vibrations felt on the chest wall where areas of lung where air are replaced with tumor or fluid. The trachea may be replaced from midline if a mass is present in the area. Nonpulmonary manifestations: heart sounds may be muffled, dysrhythmias may occur, Bones become thin with tumor invasion and break easily, may have bone pain, even heavy coughing can break a rib. Late signs usually include fatigue, weight loss, anorexia, dysphagia, and N/V. Psychosocial assessment: much fear and anxiety, guilt and shame, Few patients with stage 3 lung cancer are cured or live longer than 5 years after diagnosis. Fear of pain and death are common. Diagnostic assessment: chest x ray, CT, bronchoscopy
  5. Lung Cancer: Nonsurgical Management
    Chemotherapy side effects: N/V, alopecia, open sores on the mucous membranes, immunosupression, anemia, thrombocytopenia (decreased platelets) and peripheral neuropathy. Targeted therapy: now becoming more common in the treatment of later stage lung cancer. Take advantage of 1 or 2 differences in the cancer cell that are either not present or only slightly present in normal cells. Two agents most commonly used are erlotinib (Tarceva) an oral drug, and bevacizumab (Avastin) an IV drug. Neither drug is used alone as therapy. Radiation: usually performed daily for 5 or 6 weeks. Immediate side effects include: skin irritation and peeling, fatigue, nausea, taste changes, some have esophagitis. Drink liquid nutrition supplements like ensure. Areas may be marked with dye to outline the areas for treatment, instruct patient not to wash off the markngs, instruct not to use lotions or ointments on the skin unless the radiologist prescribes them, avoid direct sun exposure for at least one full year after treatments are completed. Eat soft bland food that is high in caloriesPhotodynamic therapy: used to be used only for palliation, now used for cure of select lung cancers. The patient is injected with an agent that sensitized the cells to light. This drug enters all cells, but leaves normal cells more rapidly. Usually within 48 to 72 hours most of the drug is collected in high concentration in the cancer cells, patient goes to OR and under anesthesia and intubation a laser light is focused on the tumor.
  6. Lung Cancer: Surgical Management
    Lobectomy: removal of a lung lobePneumonectomy: removal of the entire lung, including all blood vessels. The bronchus to that lung is severed and sutured. SegmentectomyWedge resectionHemorrhage is an early, life-threatening complication that can occur after a lung resection. It can result from bronchial or intercostal artery bleeding or disruption of a suture or clip around a pulmonary vessel.76 Excessive chest tube drainage can signal excessive bleeding. During the immediate postoperative period, chest tube drainage should be measured every 15 minutes; this frequency should be decreased as the patient stabilizes. If chest tube loss is greater than 100 ml/hr, fresh blood is noted, or a sudden increase in drainage occurs, hemorrhage should be suspected.
  7. Bronchoscopy
    Bronchoscopy. A bronchoscope is inserted through the mouth, trachea, and major bronchi into the lung, to look for abnormal areas. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a cutting tool. Tissue samples may be taken to be checked under a microscope for signs of disease.
  8. Staging: I
    Stage I non-small cell lung cancer. In stage IA, cancer is in the lung only. In stage IB, the cancer may do one or more of the following: (a) grow larger in the lung, (b) spread to the main bronchus of the lung, (c) spread to the innermost layer of the pleura that covers the lungs
  9. Staging: II
    Stage II non-small cell lung cancer. In stage IIA, cancer has spread to lymph nodes on the same side of the chest as the cancer. In stage IIB, cancer is either the same as in stage IB and has also spread to lymph nodes on the same side of the chest; or cancer has not spread to lymph nodes but has spread to one or more of the following: (a) the chest wall, (b) the diaphragm, (c) the pleura between the lungs, (d) the membrane around the heart, and/or (e) the main bronchus.
  10. Staging: IIIA
    Stage IIIA non-small cell lung cancer. The cancer has spread to the lymph nodes on the same side of the chest as the cancer. It may also spread to one or more of the following: (a) the main bronchus, (b) the chest wall, (c) the diaphragm, (d) the pleura between the lungs, and/or (e) the pericardium (membrane around the heart).
  11. Stage IIIB
    Stage IIIB non-small cell lung cancer. The cancer has spread to (a) lymph nodes above the collarbone or lymph nodes on the opposite side of the chest from the cancer, and/or it may also spread to one or more of the following: (b) the heart, (c) the inferior vena cava and the aorta, (d) the chest wall, (e) the diaphragm, (f) the trachea, and (g) the sternum or esophagus. Cancer may also spread to the fluid between the pleura (thin layers of tissue lining the lungs and chest cavity).
  12. Staging: IV
    Stage IVIn stage IV, cancer may have spread to lymph nodes and has spread to another lobe of the lungs or to other parts of the body, such as the brain, liver, adrenal glands, kidneys, or bone.
  13. Wedge resection
    Wedge resection: Surgery to remove a tumor and some of the normal tissue around it. When a slightly larger amount of tissue is taken, it is called a segmental resection
  14. Lobectomy
    Lobectomy: Surgery to remove a whole lobe (section) of the lung.
  15. Pneumonectomy
    Pneumonectomy: Surgery to remove one whole lung.