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31 terms

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