Pleural effusion Flashcards
reexpansion pulmonary edema pathophysiology?
inc pulmonary blood flow and capillary failure in ipsilateral side->cytokine inflamation on ipsi and contralateral side
treatment of complicated pleural effusion?
thoracostomy with instillation of TPA gyrase
findings of a pleural effusion from a ruptured esophagus?
exudative, low pH, and a high amylase
things that cause a transudative effusion?
cirrhosis, CHF, nephrotic syndrome, iatrogenic infusion of crytalloids into pleural space, urinothorax
defining characteristic of urinothorax?
pleural/serum Cr >1
best test for evaluation pleural effusion?
CT equivalent to US
physiology of effusion?
pleural fluid arises from parietal pleura vasculature and then is reabsorbed by the lymphatics
Lights critera?
pleural/serum: protein >.5, LDH >.6
pseudoexudate in pleural effusion?
due to diuretic use, can account for albumin (serum albumin- pleural albumin) if <1.2
bloody pleural fluid?
TB malignancy
milky pleural fluid?
chylous
anchovy paste pleural fluid?
ameoba
high triglycerides in pleural fluid?
chylothorax
high Cr in pleural fluid?
urinothorax
Post CABG pleural effusion?
L>R, exudate,
TB pleural fluid?
exudate, lymphocyte predominance, positive ADA, culture negative
drugs that cause an exudative effusion?
nitrofurantoin, methotrexate, amiodarone, phenytoin
exudate with increased amylase?
ruptured pancreatic pseudocyst
chylothorax?
milky with triglycerides >11
treatment for a retaine dhemothorax?
VATS
when to do thoracotomy for hemothorax?
> 200 cc/hr, or 1500 in 24 hour
TPA plus dornase benefit for empyema?
reduce need for surgery and decrease LOS
pleural fluid salivary isoamylase effusion cause?
boerhaave
pancreatic isoamylase in fluid?
pseudocyst
how to prevent reexpansion pulmonary edema?
limit end exp pleural pressure to -20 cm h2o, gradual removal of fluid
effusion of RA?
exudative and lymphocytic
pseudoexudate
transudative efusion with elevated protein or LDH secondary to diuretic use
how to increase specificity for exudate?
serum - pleural albumin <1.2
drugs that cause exudate?
NFT, MTX, phenytoin, amiodarone
parapneumonic effusion labs
LDH>1000, ph <7.2 need chest tube
how to treat venous air embolism?
left lateral decubitus and trendelenburg
puts RVOT lower than RV and improves RV
position for arterial air embolism
remain flat to reduce cerebral gas embolism
