PE, pneumothorax, pulmonary effusion, IPF Flashcards
Dx PE
Assess prob using Well’s
Low Well’s –> d-dimer (-ve excludes PE, +ve do CTPA)
High Well’s –> CTPA
Mx PE
Oxygen, morphine, LMWH (ionotroped if BP low)
Start warfarin
Pneumothorax Mx based if it is a … or a … pneumothorax
Primary - no underlying lung disease
Secondary - underlying lung disease
Mx tension pneumothorax
2nd intercostal space, mid clavicular line - insert bore venflon
Primary pneumothorax Mx
SOB +/or rim =or more 2cm –> Aspiration –> chest drain
If not meet this then consider discharge, review in 2 weeks
2nd pneumothorax Mx
> 2cm/breathless –> chest drain
1-2cm –> aspirate –> chest drain
less than 1 cm –> admit, oxygen
Classification of pleural effusion
Effusion protein over 35g/l - exudate
Less than 25 - transudate
25-35g/l - Lights criteria
Light’s criteria
Exudate has 1 of:
effusion : serum protein >0.5
Effusion : serum LDH ratio > 0.6
Effusion LDH is 0.6 x ULN
Send effusion tap for:
Chem - protein, LDH, pH, glucose, amylase
Micro - MCS, auramine stain, TB culture
Cytology
Immunology: SF, ANA, complement
Mx pleural effusion
Rx cause, symptomatic drainage, chemical pleurodesis if recurrent malignant effusion
Upper lung disease causes
FASTEN Farmer's lung Ank spond Sarcoidosis/silicosis TB EAA Neurofibromatosis
Lower lung disease causes
ARDS Asbestosis Rheum conditions (not AS) Silicosis/scleroderma Drugs
Drug causes of fibrosis
BANS ME Bleomycin Amiodarone Nitrofuratoin Sulfasalazine Methotrexate, MEthysergide
Causes of EAA
Bird fancier’s lung
Farmer’s/mushroom
Malt worker - aspergillus
Acute EAA presentation
Fever, rigor, malaise
Dry cough, dyspnoea
Crackles (no wheeze)
