Ch 69 Pleural Effusion

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Pleural Effusionn

Accumulation of fluid in pleural space., between the visceral and parietal pleura

Pulmonary Edema

fluid on the lung surface

Seen in pts with pleural effusion

compressed lung, mediastinal shift (AWAY from bad side), Depressed diaphragm, Atelectasis, Compression of great veins.

Transudate

Thin, watery fluid, FEW blood cells, PULMONARY CAPILLARIES LEAK to pleural space.

#1 cause of transudate fluid

CHF

Exudate

A lot of blood cells (increased WBC'S) Develops with DIsease..INFECTION, PNEUMONIA, MALIGNANY,TB, FUNGAL DISEASE

Empyema

accumulation of PUS in pleural space, INFECTION, INFLAMMATION

Hemothorax

prescence of BLOOD in pleural CHEST TRAUMA, Check Hct of the pleural fluid, needs to be at least 50% blood to be considered a hemothorax

Chylothorax

prescense of CHYLE in pleural space, MILKY liquid produced from digestion, transported by lymphatic system(thoracic duct), HEAD NECK TRAUMA

Pleural Effusion Clinical Features

Dyspnea, Chest pain, Hypoxema

dx of Pleural Effusion

Breath sounds(Abscent over the effusion), Percussion, Dull or Flat over FLUID, CXR

CXR

Blunting of costophrenic angle.White-=fluid/consolidation..Tracheal deviation

LATERAL DECUBITIS

CXR laying on affected side, FLUID moves when pt lays on affected side, SOLID would not move or shift..Identifies FLUID or SOLID

tx of pleural effusion

Thoracentesis(used to dx and tx), Pleurodesis(prevent REOCCURANCE of accumulated pleural fluid. TALC injected into chest cavity, visceral and parietal stick together., Thoracentesis(used to dx and tx), Pleurodesis(prevent REOCCURANCE of accumulated pleural fluid. TALC injected into chest cavity, visceral and parietal stick together.

Thoracentesis

Fluid aspirated through needle inserted into chest wall to dx and remove ALL the fuid

Pleurodesis

prevent REOCCURANCE of accumulated pleural fluid. TALC injected into chest cavity, causing visceral and parietal to stick together.

Pneumothorax

Air accumulation in pleural space..trachial deviation AWAY from affected side

Traumatic Pneumo

Penetrating would to chest wall.

Open Pneumo

Pleural space in direct contact with atmosphere "sucking chest wound"

Closed Pneumo

Pleural space NOT in direct contact with atmosphere.

Tension Pneumo

MOST DEADLY, ACUTE DISTRESS.."one way valve" Air enters on Inspiration, but can't escape..Air gets trapped, compressing the intrathoracic vessels impairing venous return CAUSING reduced cardiac output, hypoxemia.

Emergency tx of pneumo

large bore needle inserted into 2nd intercostal space(mid-clavicular) CRT

Primary Spontaneous Pneumo

Unsuspected, Arise in healty people without cause, 20-40 year old men, tall and thin...Rupture of bleb(blister on lung surface)

Bleb larger than 5 cm is called a

Bullae

Secondary Spontaneous Pneumo

Occurs in pt with underlying lung disease, COPD

Iatrogenic Pneumo

Occurs during diagnostic or therapeutic procedure..ex. mech ventilation, thoracentesis, biopsy, chest tube insertion, tracheostomy.

Clinical Features

Sudden dyspnea, dry cough, chest pain, cyanosis, tachycardia HYPERRESONANT percussion, ABSCENT breath sounds, Tracheal deviation AWAY from affected side, Subcutaneous emphysema

dx of pnemo

CXR.

Deep Sulcus Sign

radiologic finding in a pneumo..costraphrenic angle dipped down.

tx of pnemo

<20%, NO tx..>20%..pleurodesis, Supportive O2 therapy, Thoracentesis, Chest tube, Surgical

VATS

Video Assisted thoracic surgery...staples, bullectomy

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