Respiratory

Question 1

What are the biochemical features of exudate from effusion?

Answer 1

Purulent pleural fluid
* + gram stain / culture
* WCC > 50,000
* Pleural fluid glucose <3
* Pleural fluid pH <7.2
* Pleural fluid LDH >1000

Question 2

What is the Lights criteria for exudate

Answer 2

Lights criteria (High protein and LDH = exudate), determines presence of exudate with protein and LDH levels
Pleural fluid protein to serum protein ratio >0.5
Pleural fluid LDH to serum LDH ratio >0.6
Pleural fluid level >2/3 of upper value for serum LDH

Question 3

What are the US features of empyema?

Answer 3

Loculation
effusion
consolidation

Question 4

What are the steps in management for empyema?

Answer 4

Supportive - Oxygen, analgesia, fluids
Medical - Iv abx eg tazocin or vanc if MRSA. 20fr chest drain
Surgical - fibrinolytics via chest drain, VATS (video assisted thorascopic surgery). open thoracotomy