Pleural Disease
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| collections of fluid in the pleura? | pleural effusion
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| collection of air in the pleura? | pneumothorax
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| inflammation of pleura w/o fluid? | pleuritis
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| Adheres to chest wall blood from systemic capillaries lymphatic drainage innervated (pain)? | parietal pleura
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| adheres to lung covers each lobe blood from bronchial arteries limited lyphatic drainage no innervation (no pain)? | visceral pleura
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| parietal and visceral pleura meet at _____? | hila
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| What occurs if fluid drainage < fluid formation? | pleural effusion
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| What is not an end dx, but a symptom and complication of another condition? | pleural effusion
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| Exam? Decreased breath sounds, dullness to percussion, decreased fremitus at level of effusion; +/-increased breath sounds above | pleural effusion
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| True or False? Pleural effusions are always abnormal | True
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| What is cuased by either excess production of fluid or decreased drainaged of fluid? | pleural effusion
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| Type of Pleural Effusion? -Disorders of hydrostatic and/or oncotic forces -Fluid seeps from vessels/interstitium (or is squeezed out) -Paucicellular | transudative
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| Types of Pleural effusion? -Disorders of inflammation -Fluid exudes through wide gaps between cells -Rich in cells | exudative
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| Causes what type of effusion? Congestive Heart Failure Nephrotic Syndrome Hypoalbuminemia Cirrhosis Pericardial Disease Myxedema Pulmonary Embolus Sarcoidosis | transudative
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| imbalance of hydrostatic and oncotic forces allowing fluid to leave the cells in the interstitial? | third spacing
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| Cuases what type of effusion? Long List: all condition cause some sort of inflammatory response, cell growth, or cell turnover. | Exudative
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| Conditions that can cause both transudative and exudative effusion? | PE, Sarcoidosis
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| ? -Bedside procedure -Sterile technique -Needle OVER rib | thoracentesis
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| Amount of fluid for diagnostic thoracentesis? | 10-20cc
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| Amount of fluid for therapeutic thoracentsis? | up to 1L
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| Classic way to differentiate between transudative and exudative? | light's criteria
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| Pleural fluid rich in protein and LDH, indicate what type of effusion? | exudative
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| Exudative effusion list narrowed becuase of? Complicated parapneumonic, esophageal rupture, rheumatoid arthritis, T.B., malignancy, lupus, urinothorax, paragonimiasis | pH < 7.2
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| Exudative effusion list narrowed becuase of? Parapneumonic, malignant, T.B., rheumatoid arthritis, hemothorax, paragonimiasis, Churg-Strauss | glucose < 60 mg/dl
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| Bacterial infections --> empyema and some malignant effusions, need what tx? | chest tube
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| Do transudative effusions need a chest tube? | no
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| True or false? must analyze the pleural fluid to determine the type of effusion? | true
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| Physical signs: hyperresonant, diminished tactile and vocal fremitus, and decreased or absent breath sounds? | pneumothorax
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| CXR: peripheral absence of lung markings and the presence of a pleural stripe? | pneumothrorax
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| 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
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| Type of pneumothorax? -Blebs usually apical -Sheer forces greater in apices -Spontaneous rupture allows air to reach pleural space | primary spontaneous
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| 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
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| Penetrating chest injury, blunt chest injury, or iatrogenic cause what type of pneumothorax? | traumatic
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| 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
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| Most common cuase of tension pneumothorax? | mechanical ventilation
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| True or False? if you make dx of tension pneumothorax with CXR, *YOU'RE TOO LATE* | true
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| Presentation of what type of pneumothorax? -Low blood pressure -Absent/decreased breath sounds -Hyperresonance to percussion +/- Tracheal deviation (away from affected side) | tension
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| Management of Tension pneumothorax? | needle decompression (18ga. in 2nd ICS, leave it there)
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| 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
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| 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
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| Management options for pneumothorax? -larger, more symptoms, more comorbiditieds -more likely for secondary spontaneous | chest tube (tube thoracostomy)
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| true or false? Every pt. w/ pneumothorax on vent gets a chest tube. | true
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| true or false? every pt. on vent gets a chest tube. | false
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| Management options for pneumothorax? -If pneumothorax or air leak persists for 'several' days despite chest tube | refer (to thoracic surgery)
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| 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
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| What type of pneumothorax includes a sicker population, who tend to do worse? | secondary spontaneous
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| 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
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| Risk of recurrence of pneumothorax in next 5 years? | 20%
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| Ddx for what? Costochondritis, zoster, rib fracture, other chest wall abnormalities | pleuritis
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| Most common cause of pleuritis? | viral (benign)
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