Pleural Space Disease

Question 1

What do patients with pleural space defects present with?

Answer 1

Progressing dyspnea associated with a rapid shallow breathing pattern and some degree of muffled lung sounds on auscultation. The more acute the condition, the more distress the patient is.

Question 2

What diagnostics should you perform with pleural space defect?

Answer 2

FAST exam to identify and differentiate between air, fluid or solid structure. Thoracocentesis is contraindicated if there is a suspicion of diaphragmatic hernia (suspected when gastrointestinal sounds are prominent on auscultation of the thoracic cavity or via abdo palpation). If DH suspected, radiographs should be taken after stabilization.

Question 3

Pneumothorax

Answer 3

Remove as much air as possible and consider chest tube if there is no end point.
A series of small holes takes a couple of days to resolve and frequently without surgery.
Large rents in lung tissue, severely damaged lung tissue, or air entering from the outside the thoracic cavity may need surgery.

Question 4

What other fluids could you find during a thoracocentesis?

Answer 4

Chylous, transudative, exudative, serosanguineous or sanguineous fluid

Question 5

Purulent fluid

Answer 5

Antibiotics

• should be based in culture and sensitivity
• while awaiting results = use broad spectrum antibiotic
• thoracic lavage for moderate to severe cases
• bilateral chest tubes may be needed
• 10-20ml/kg of warm sterile physiologic saline every 6-12 hourly for 3-6 days

Question 6

Thoracotomy - when is it indicated?

Answer 6

• if not responding to therapy
• a lung or pleural abscess is suspected
• a foreign body is suspected
• a neo plastic process is suspected
• pocketed fluid cannot be drained successfully by thoracotomy tubes

Question 7

What happens when you remove blood from the chest?

Answer 7

-do not remove all the blood but only enough to help patient breathe better and facilitate adequate oxygenation

Question 8

What are the causes for a hemothorax?

Answer 8

Severe coagulopathies, blunt or penetrating traumas, neoplasia, pulmonary thromboembolism, lung lobe torsion, dirofilariasis and diaphragmatic hernia

Question 9

What is the most common cause of a severe coagulopathy leading to hemothorax?

Answer 9

Anticoagulant rodenticides

Question 10

Why should you leave some blood in the chest cavity?

Answer 10

They can be reabsorbed and recycled by the body.

Internal pressure bandage to help decrease some of the bleeding.