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Pleural Disease

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 -Incidence 7.4/100,000/year in males 1.2/100,000/year in females primary spontaneous
Type of pneumothorax? -Blebs usually apical -Sheer forces greater in apices -Spontaneous rupture 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 n reduce blood flow from 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)
Created by: duanea00