RE: Diaphragmatic hernia repair

KirstyJaneRVN — Sun, 31 Jul 2016 22:29:14 GMT

Wow Susanna thanks so much for your response, sorry yes rupture after suspected RTI (scuffed claws). Thanks again for your time, Really, really appreciate it! :D

RE: Diaphragmatic hernia repair

Susanna Taylor — Sun, 31 Jul 2016 18:35:06 GMT

Btw is it hernia or rupture?

hermia is congenital, rupture is traumatic. Has effect on rest of case ie chronic effects vs other trauma

RE: Diaphragmatic hernia repair

Susanna Taylor — Sun, 31 Jul 2016 18:32:31 GMT

Hi. Sorry just a quick post with a few pointers Pre oxygenate even if stable Carefully cuffed et tube Keep chest elevated from induction. Know what if any viscera are in the thorax. Vet may be able to do a bit of a wiggle to get things to move down. Be prepared you may need to ippv from induction. Some are fine without until first cut, some go downhill quickly Have 2 nurses from start - dedicated anaesthetist Watch capnograph for hypocapnia indicating low TV - ippv indicated. This should raise etco2 to ideally >30 Aim ippv for normal movement and timings. View lungs. Only partially close apl valve on t piece to avoid v high pressures. If lungs are atelectic from being squashed, you want slower and lower pressure breaths until they reinflate. Gradually increase pressure Research recruitment manoeuvre if you get chance. If chest drain placed, ask for intercostal local blocks. Use lido/adrenaline - super cheap and effective. Don't be afraid of full opioids for pain relief. Better long term than bup as pain is worst for breathing! Good luck. :-). Sorry if typos!