Accumulation of fluid in pleural space., between the visceral and parietal pleura
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.
Thin, watery fluid, FEW blood cells, PULMONARY CAPILLARIES LEAK to pleural space.
#1 cause of transudate fluid
A lot of blood cells (increased WBC'S) Develops with DIsease..INFECTION, PNEUMONIA, MALIGNANY,TB, FUNGAL DISEASE
accumulation of PUS in pleural space, INFECTION, INFLAMMATION
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
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
Blunting of costophrenic angle.White-=fluid/consolidation..Tracheal deviation
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.
Fluid aspirated through needle inserted into chest wall to dx and remove ALL the fuid
prevent REOCCURANCE of accumulated pleural fluid. TALC injected into chest cavity, causing visceral and parietal to stick together.
Air accumulation in pleural space..trachial deviation AWAY from affected side
Penetrating would to chest wall.
Pleural space in direct contact with atmosphere "sucking chest wound"
Pleural space NOT in direct contact with atmosphere.
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
Secondary Spontaneous Pneumo
Occurs in pt with underlying lung disease, COPD
Occurs during diagnostic or therapeutic procedure..ex. mech ventilation, thoracentesis, biopsy, chest tube insertion, tracheostomy.
Sudden dyspnea, dry cough, chest pain, cyanosis, tachycardia HYPERRESONANT percussion, ABSCENT breath sounds, Tracheal deviation AWAY from affected side, Subcutaneous emphysema
dx of pnemo
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
Video Assisted thoracic surgery...staples, bullectomy