cardiothoracic Flashcards
what is a pleural effusion?
the accumulation of fluid in the pleural space that can be transudate or exudate
what are symptoms of a pleural effusion?
- dyspnoea
- pleuritic chest pain
- cough
- fever
- chills
- weight loss
what is transudate?
low protein content due to cahnges in oncotic and hydrostatic forves
what are causes of transudate pleural effusion?
congestive heart failure ascites cirrhosis hypoalbuminaemia nephrotic syndrome
what is exudate?
high in protein and contains more lactate dehydrogenase
due to inflammatory/ infection neoplastic syndromes
what is the medical management options for a pleural effusion?
- diuretics
- physio
- antibiotics
what diuretics are good for pleural effusion?
- often durosemide is used
- if they have refractory volume overload non loop diuretics can be helpful
what antibiotics are good for pleural effusion?
- amoxicillin
- clindamycin
- not aminoglycosides
what are surgical options for pleural effusion?
- therapeutic thoracocentesis
- tube thoracostomy
- drainage catheter placement
- pleurodesis
what is therapeutic thoracocentesis?
A needle catheter is used going above the rib in the lateral chest wall
when is thoracocentesis used for pleural effusion?
- larger than 1cm
- causing symptoms
- doesn’t meet the criteria for chest drainage
what are possible complications of thoracocentesis?
- pneumothorax
- haemothorax
- laceration
what is pleurodesis?
obliteration of the pleural space to prevent recurrent pleural effusions
what agents are typically used for pleurodesis?
- talc
- silver nitrate
what are medical options for a pneumothorax?
- high flow oxygen
- chemical pleurodesis
when is high flow oxygen used for pneumothorax?
- patients with a secondary pneumothorax that is under 1cm and observed for 24 hours
what are surgical options for pneumothorax?
- intercostal drain
- aspiration
- chest drain
what is the first line treatment surgically for all pneumothoraxs needing intervation?
aspiration
when is chest drain suction used for a pneumothorax?
- tension
- over 2cm making them breathless
