PulmonarySurgeries for Physiotherapists .pptx

Brief Information for students about Pulmonary Surgeries

1. PULMONARY SURGERY & PHYSIOTHERAPY Dr. Krishna Priya (MSCPT ) Yoga Instructor (QCI) Dr. Krishna Priya (PT)

2. Lecture Objectives Basic anatomy and functioning of Lungs Why is Surgery required? What Surgical procedures are done? Types of incisions used Problem list Choosing Physio techniques from your tool box Dr. Krishna Priya (PT)

3. LUNGS Dr. Krishna Priya (PT)

4. Broncho Pulmonary Segments Dr. Krishna Priya (PT)

5. Gaseous Exchange Dr. Krishna Priya (PT)

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7. Why Sx Damaged tissue – high chances of frequent, recurrent damages and infections Effects on surrounding tissues and generalised responses Dr. Krishna Priya (PT)

8. Pulmonary Sx C ancer, Infection, COPD Lobectomy Pneumonectomy Wedge resection Pleural Sac removal in Pleurodesis - recurrent infections Lung Transplantation Dr. Krishna Priya (PT)

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10. Procedures Biopsy Thoracocentesis – pleural tapping Dr. Krishna Priya (PT)

11. AIMS Area Exposure Understand surface anatomy and pathology using investigations Preserving to maximum extent Chest wall function and appearance post Sx Dr. Krishna Priya (PT)

12. Should Understand Otomy – opening Scopy – pinhole surgery Eg . Laprotomy / Laproscopy Thorocotomy / Thorocoscopic Procedure. VATS - Video assisted Thoracoscopic Sx Dr. Krishna Priya (PT)

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14. Incisions Dr. Krishna Priya (PT)

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16. Incision types Median Sternotomy Pacemaker incision Thorocotomy - Posterolateral , Anterolateral, Axillary Clamshell Dr. Krishna Priya (PT)

17. Median sterrnotomy Open heart, Lung transplant, valve replacement Disadv : Scar, Pain Adv : muscles spared Dr. Krishna Priya (PT)

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19. Pacemaker incision Dr. Krishna Priya (PT)

20. Left infraclavicular region – horizontal/oblique incision Pacemaker subcutaneous insertion Dr. Krishna Priya (PT)

21. Posterolateral Thoracotomy M ost commonly used incision for Thoracic Viscera Pneumonectomy Lobectomy Chest wall resection Dr. Krishna Priya (PT)

22. Muscles effected Incision from Mid spinal line to ant axillary line Latissimus Dorsi Serratus Anterior Rhomboids Trapezius Dr. Krishna Priya (PT)

23. Anterolateral incision For Cardiac, Thoracic, Oesophageal Surgeries Extends from lateral sternum to mid axillary line 4/5 th ICS Dr. Krishna Priya (PT)

24. Muscles effected - Pec Major, Pec Minor, SA Dr. Krishna Priya (PT)

25. Axillary Incision Posterior border of Pec Major, Ant border of Lats 4/5 th ICS Adv - Muscle sparing Disad – limited exposure to thoracic viscera Pneumothorax Dr. Krishna Priya (PT)

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27. Clamp Shell Incision Transverse incision below the nipple 4/5 th ICS Pec . Major Dr. Krishna Priya (PT)

28. Disadv : Severe pain Prolonged respiratory insuffiency Adv : Better exposure to all the thoracic organs and viscera Complex heart defects Pleural cavity Transplant surgeries Dr. Krishna Priya (PT)

29. VATS Reduced mortality with this procedure Extreme care has to be taken Anatomical considerations – heart, abdomen, subclavian vessels, pulmonary artery, air leaks causing pneumo peritoneum, phrenic nerve, trachea, eosophagus , sympathetic chain posteriorly Dr. Krishna Priya (PT)

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31. Robotic Surgery Dr. Krishna Priya (PT)

32. PROBLEM LIST Pain - muscles and tissue cut Drugs - Nausea Many connections to and from the patient R educed lung volumes Hypo-activation & weakness of respiratory muscles Anaesthesia effect on respiratory tract – reduced mucociliary transport Fatigue Dr. Krishna Priya (PT)

33. Complications DVT Infection Atelectasis Bleeding MSK pain - neck and shoulder Neural tissue damage Postural Hypotension Disorientation Incision dehiscence Dr. Krishna Priya (PT)

34. From the Physio tool box Problem Technique Pain Medications, Early mobilization, Diaphragmatic breathing Connections Careful management of the drain tubes, catheters, IV lives, stockings etc.. Reduced Lung volumes Deep breathing exercises, Incentive spirometry Reduced Mucociliary transport Splinted coughing Fatigue Early mobilization with assurance and great care Hypoventilation/atelectasis Body positioning – for ventilation, perfusion and drainage Elevated positions Inactivity Patient education about faster shifting from ICU and HOSPITAL with better performance Dr. Krishna Priya (PT)

35. Phases of rehab Pre Op Immediate Post Op- Day of Sx / POD1 In Wards Home Therapy and Mx - Teach self management / to the attenders Dr. Krishna Priya (PT)

36. ANY DOUBTS??? THANK YOU Dr. Krishna Priya (PT)