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25 Cards in this Set
- Front
- Back
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pleural effusion of fluid is normal in what amount? |
5 to 5 mL/ |
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4 pathological processes in pleural effusions |
Transudates exudates empyema hemothorax |
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transudates are what? |
Increased fluid in the setting of normalcapillaries dueto increased hydrostatic or decreased oncotic pressures |
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Exudates are what? |
•Increasedfluid due to abnormal capillary permeability •Decreasedlymphatic clearance of fluid from pleural space |
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Empyema is what? |
•Infection in pleural space |
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hemothorax is what? |
blood in pleural space |
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causes of transudates are what? |
CHF - 90% cirrhosis with ascites. nephrotic syndrome. peritoneal dialysis. |
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causes of exudatesare what? |
•Pneumonia** •Cancer** •PE •Bacterial,viral, fungal, parasitic •PostMI-more inflammatory •Sarcoid •Chronicatelectasis Asbestos |
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s& s for pleural ds |
pretty non specific so far. larger may be dull to percussion. dyspnea, cough or chest pain. massive effusions may cause tracheal shift. |
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dx of pleural ds with thoracentesis |
thoracentesis. visualize fluid color, consistency ect. Send to lab to get protein, pH, LDH, WBC, glucose, cytology, g stain, culture and sensitivity. transudate vs exudate |
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visualization interpretation grossly purulent or milky white |
white =empyema or high in triglycerides from traumatic disruption of thoracic duct. |
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when is an effusion from an exudate? |
effusion that has one or more of the following: ratio or pleural fluid protein to serum protein >0.5 or ratio of pleural fluid LDH to serum LDH >0.6 or pleural fluid LDH > 2/3 the upper limit of nl serum LDH |
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when is a pleural ds a transudate? |
transudates have none of the features mentioned in exudates. distinguishing lab findings are glucose = serum glucose pH between 7.4 and 7.55 and < 1000 wbc/mcl with a predominance of mononuclear cells. |
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CXR in pleural diseases? what can it ID |
75 to 200 mL fluid. |
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malignant pleural effusion is most common inling and breast cancer. true or who cares? tx? |
true drainage with indwelling cath if needed. |
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how often do exudates appear with bacterial pneumonias? what are they called |
40% . parapneumonic pleural effusion. |
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3 categories of parapneumonic pleural effusion. |
simpe or uncomplicated. complicated empyema |
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uncomplicated parapneumonic pleural effusion tx |
free flwoing steril exudates or modest size tha resolve quickly with abx. no drainage needed. |
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empyema parapneumonic pleural effusion tx |
–Grossinfection of pleural space indicated by positive Gram stain or culture –Empyemashould always be drained + antibiotics |
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Complicated parapneumonic effusions tx |
Drainage of empyema or complicatedparapneumonic effusions is frequently complicated by loculation: – Intrapleural injection of fibrinolytic agents: •Streptokinase,250,000 units •Urokinase, 100,000 units |
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how to define Complicated parapneumoniceffusions: |
•Lowglucose level, low pH, or evidence of loculation –Tube thoracostomy if glu is < 60 mg/dL orpH is < 7.3. |
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spontaneous pneumothorax . who gets them |
mainly tall thin males 10 to 30 years old. risk factors are family hx. smoking. marfans. |
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secondar pneumothorax risk factors |
obstructive ds. infection. interstitial lung ds. medications. way to be specific. |
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prognosis with spontaneous pneumo and recurrence rates? what should they avoid? |
recurrence is 30% amd 50% with smokers. avoid high altitudes. flying in unpressurized aircraft scuba diving. |
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how to tx pneumo? |
small bore cather. remember that. Small bore. smal bore. |
