Question | Answer |
collections of fluid in the pleura? | pleural effusion |
collection of air in the pleura? | pneumothorax |
inflammation of pleura w/o fluid? | pleuritis |
Adheres to chest wall
blood from systemic capillaries
lymphatic drainage
innervated (pain)? | parietal pleura |
adheres to lung
covers each lobe
blood from bronchial arteries
limited lyphatic drainage
no innervation (no pain)? | visceral pleura |
parietal and visceral pleura meet at _____? | hila |
What occurs if fluid drainage < fluid formation? | pleural effusion |
What is not an end dx, but a symptom and complication of another condition? | pleural effusion |
Exam?
Decreased breath sounds, dullness to percussion, decreased fremitus at level of effusion; +/-increased breath sounds above | pleural effusion |
True or False? Pleural effusions are always abnormal | True |
What is cuased by either excess production of fluid or decreased drainaged of fluid? | pleural effusion |
Type of Pleural Effusion?
-Disorders of hydrostatic and/or oncotic forces
-Fluid seeps from vessels/interstitium (or is squeezed out)
-Paucicellular | transudative |
Types of Pleural effusion?
-Disorders of inflammation
-Fluid exudes through wide gaps between cells
-Rich in cells | exudative |
Causes what type of effusion?
Congestive Heart Failure
Nephrotic Syndrome
Hypoalbuminemia
Cirrhosis
Pericardial Disease
Myxedema
Pulmonary Embolus
Sarcoidosis | transudative |
imbalance of hydrostatic and oncotic forces allowing fluid to leave the cells in the interstitial? | third spacing |
Cuases what type of effusion?
Long List: all condition cause some sort of inflammatory response, cell growth, or cell turnover. | Exudative |
Conditions that can cause both transudative and exudative effusion? | PE, Sarcoidosis |
?
-Bedside procedure
-Sterile technique
-Needle OVER rib | thoracentesis |
Amount of fluid for diagnostic thoracentesis? | 10-20cc |
Amount of fluid for therapeutic thoracentsis? | up to 1L |
Classic way to differentiate between transudative and exudative? | light's criteria |
Pleural fluid rich in protein and LDH, indicate what type of effusion? | exudative |
Exudative effusion list narrowed becuase of?
Complicated parapneumonic, esophageal rupture, rheumatoid arthritis, T.B., malignancy, lupus, urinothorax, paragonimiasis | pH < 7.2 |
Exudative effusion list narrowed becuase of?
Parapneumonic, malignant, T.B., rheumatoid arthritis, hemothorax, paragonimiasis, Churg-Strauss | glucose < 60 mg/dl |
Bacterial infections --> empyema and some malignant effusions, need what tx? | chest tube |
Do transudative effusions need a chest tube? | no |
True or false? must analyze the pleural fluid to determine the type of effusion? | true |
Physical signs: hyperresonant, diminished tactile and vocal fremitus, and decreased or absent breath sounds? | pneumothorax |
CXR: peripheral absence of lung markings and the presence of a pleural stripe? | pneumothrorax |
Type of pneumothorax?
-No underlying lung disease
-Peak incidence in 3rd decade
-Rare after 40 yrs old
-Incidence7.4/100,000/year in males 1.2/100,000/year in females | primary spontaneous |
Type of pneumothorax?
-Blebs usually apical
-Sheer forcesgreater in apices
-Spontaneousrupture allows air to reach pleural space | primary spontaneous |
Conditions cause what type of pneumothorax?
COPD
Pneumocystis carinii pneumonia (AIDS)
Tuberculosis
Necrotizing pneumonia
Cystic fibrosis
Asthma
Idiopathic interstitial pneumonia
Connective tissue disease
Pneumoconiosis
Lung cancer | secondary spontaneous |
Penetrating chest injury, blunt chest injury, or iatrogenic cause what type of pneumothorax? | traumatic |
Type of pneumothorax?
-Rapid accumulation of air in pleural space
-Associated rise in pleural pressure
-This pressure ca nreduce blood flowfrom vena cava to right heart
-Cardiac output drops,further reducing venous return-->SHOCK, DEATH | tension |
Most common cuase of tension pneumothorax? | mechanical ventilation |
True or False? if you make dx of tension pneumothorax with CXR, *YOU'RE TOO LATE* | true |
Presentation of what type of pneumothorax?
-Low blood pressure
-Absent/decreased breath sounds
-Hyperresonance to percussion
+/- Tracheal deviation (away from affected side) | tension |
Management of Tension pneumothorax? | needle decompression (18ga. in 2nd ICS, leave it there) |
Management options for pneumothorax?
-If a pneumothorax is small, limited symptoms
-Can add 100% O2 by facemask (promotes resorption of pleural air)
-Repeat CXR | observation |
Managment for pneumothorax?
-Almost exclusively for Primary, Spontaneous
-3 way valve, syringe inserted into pleural space, aspirate, close valve, empty syringe (repeat)
-Stop when feel resistance to aspiration or patient starts coughing
-Repeat CXR | needle apsiration |
Management options for pneumothorax?
-larger, more symptoms, more comorbiditieds
-more likely for secondary spontaneous | chest tube (tube thoracostomy) |
true or false? Every pt. w/ pneumothorax on vent gets a chest tube. | true |
true or false? every pt. on vent gets a chest tube. | false |
Management options for pneumothorax?
-If pneumothorax or air leak persists for 'several' days despite chest tube | refer (to thoracic surgery) |
Type of management of pneumothorax?
-No flying for several weeks
-2 weeks may be enough if patient is otherwise healthy
-Up to 6 weeks if PTX was traumatic and patient has comorbidities | long term |
What type of pneumothorax includes a sicker population, who tend to do worse? | secondary spontaneous |
What type of pneumothorax is treated more aggressively because patients do not tolerate the pneumothorax well and underling disease makes spontaneous resolution difficult? | secondary spontaneous |
Risk of recurrence of pneumothorax in next 5 years? | 20% |
Ddx for what?
Costochondritis, zoster, rib fracture, other chest wall abnormalities | pleuritis |
Most common cause of pleuritis? | viral (benign) |