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Narcotics are rarely given before thoracic surgery because they can depress respiration. Usually the preoperative medication is atropine in combination with a barbiturate.
The development of intensive care units has sharply improved the care of the post-thoracotomy patient. The availability of monitors, ventilators, and special assist devices has increased not only the safety of the operation but also the comfort of the patient. Many patients return from the operating room with endotracheal tubes still in place, ventilated by machines, and monitored with such special equipment as Swan-Ganz catheters for observation of cardiac output, oxygenation, and level of hydration.
During the postoperative period, alteration in respiratory status is a major potential problem for patients having thoracic surgery. Impaired gas exchange can result from atelectasis, pneumothorax, mediastinal shift, bronchopulmonary fistula, pneumonia, pleural effusion, pulmonary edema, narcotics, or abdominal distention. To identify any change in respiratory status, the patient's arterial blood gases are serially monitored, breath sounds are auscultated, and the rate and character of respirations are assessed. To facilitate removal of obstructive mucus and other secretions in the air passages the patient is encouraged to deep breathe and cough every one to two hours. Chest physical therapy may be ordered to help mobilize the secretions so that they are more easily coughed up. The amount and character of sputum is noted and recorded. If necessary, nasotracheal suctioning may be done to help clear the air passages. Oxygen may be administered to prevent anoxia.
The patient is also periodically assessed for pain, abdominal distention, and alteration in cardiac function related to decreased cardiac output, arrhythmias, or cardiac tamponade. If the pericardial sac becomes filled with fluid and produces an acute cardiac tamponade, an emergency pericardiocentesis may be necessary.
Almost all patients having thoracic surgery will have chest tubes. (One exception is the patient who has had a lung removed. In this case fluid is deliberately allowed to accumulate in the pleural space to prevent mediastinal shift.) Chest tubes are attached to closed drainage systems to avoid pneumothorax and allow for drainage of the pleural space and gradual reexpansion of the lung. (See chest tube for care.)
As the operative site heals and the lung expands, the chest tubes can be safely removed. After their removal an airtight bandage is applied to the area. As a precaution against leakage of air into the chest cavity, the physician may apply petrolatum to the edges of the wound before applying the dressing.
thoracic/tho·rac·ic/ (thah-ras´ik) pectoral; pertaining to the thorax (chest).
thoracicadjective Pertaining to the chest.
thoracicadjective Pertaining to the chest
thoracicPertaining to the chest.
Patient discussion about thoracic
Q. My mother had a chest pain and she was sent for a TEE. When do you need a TEE and when a normal echo is fine? My mother had a chest pain few weeks ago. we were sure its a heart attack and went to the ER. There the doctors did some tests and she was sent for a (trans thoracic echocardiogram) TEE. I want to know when do you need a TEE and when you can do just a normal echocardiogram because the TEE was very painful for her and we want to know if ther was a better way.
As far as I know there are some heart situations the TEE is better for diagnosis that normal echo. Maybe your mom had one of those situations?
I can recommend you to ask the ER doctor. he will probably be able to give a better explanation for his choice