Chest Pain & Shortness of Breath

Surgery

Assumptions

The student will have an understanding of chest and cardiac anatomy and physiology including esophageal motility. The student should be able to interpret chest radiographs and ECG’s.

Knowledge Objectives

Through their reading and patient care experiences, at the end of the rotation students should be able to:

Describe the causes, diagnosis, and treatment of spontaneous pneumothorax
Discuss the risks of pneumothorax which could prove life-threatening.
Discuss the underlying pulmonary pathology you might expect to find
Discuss the role of: observation, tube thoracostomy, chemical sclerosis, and surgical management of this condition.
Discuss the likelihood of recurrence and occurance on the opposite side.
Describe the common etiologies for hemothorax.
Discuss an appropriate diagnostic evaluation for a patient with hemothorax.
Discuss the appropriate management of blood in the pleural cavity.
Which patients need an operation?
What are the risks in leaving the blood in the chest?
Discuss the most common non-traumatic causes of hemothorax.
Describe the presentations, etiologies and management of pulmonary embolus.
Discuss the predisposing factors which may lead to PE.
Discuss the electrocardiographic changes which might be seen and how they might be distinguished from those of myocardial infarct.
Discuss the main points in the diagnostic evaluation for PE.
Discuss management options:
Who needs anticoagulation with heparin?
Who needs lytic therapy?
Who needs vena caval filter protection?
Discuss the indication for open thoracotomy and pulmonary embolectomy to treat massive embolism.
Identify patients at significant risk for DVT who need prophylaxis
Describe the presentation, etiology and management of acute thoracic aortic dissection.
Discuss initial medical vs. surgical management
Discuss the goals of medical management and the role of beta-blockers and blood pressure control.
Discuss the usual sites of dissection within the proximal aorta and how the location affects prognosis and management.
Discuss issues as they relate t aortic valve competence, distal re-entry site of the dissection, presence of hemothorax.
Discuss the primary risks associated with surgical repair of the dissected aorta (hemorrhage, paraplegia, stroke, MI, visceral ischemia in abdomen).
Describe the usual presenting symptoms and etiology of esophageal rupture.
Discuss the most common causes of rupture.
Discuss the sites within the esophagus most frequently perforated.
Discuss the risks of untreated perforation.
Discuss the indications for surgical management of esophageal perforation.
Which patients may be safely managed non-operatively?
Discuss the treatment priorities in treating most esophageal perforations.
Discuss the relationship of underlying esophageal disease to treatment options in the management of perforation.
Describe the common presenting symptoms associated with gastro-esophageal reflux.
Discuss the relationship of reflux to chronic asthma and aspiration.
Discuss the appropriate diagnostic work-up of a patient with suspect reflux. What is the role of barium swallow, endoscopy, manometry, 24 hour pH testing?
Discuss the evaluation of dysphagia.
Discuss the treatment of esophageal stricture. What are the risks of dilation?
Discuss Barrett’s esophagus and its implications.
What are the risks of malignancy?
Who needs surgical management and which procedure (antireflux or resection) is needed?
Discuss surgical options for reflux (consider abdominal or thoracic, laparoscopic vs. open. Partial vs. complete wrap)
Discuss the pathophysiology and treatment of achalasia and diffuse esophageal spasm.
Describe the clinical findings, symptoms, and etiology of empyema.
Discuss the clinical situations likely to be associated with formation of an empyema.
Discuss the usual organisms isolated in culture.
Discuss the management options for treating empyema and the differences in management of empyema in children.
Discuss the surgical options in the management of empyema.
Discuss the risks of pneumothorax which could prove life-threatening
Discuss the underlying pulmonary pathology you might expect to find.
Discuss the role of observation, tube thoracostomy, chemical sclerosis, and surgical management of this condition.
Discuss the likelihood of recurrence and occurrence on the opposite side.