1. Pleural Diseases - Banz

• Visually difference

  • exudate - cloudy
  • transudate - clear
• Use these 3 criteria for Pleural Exudates:

  1. pleural fluid protein/serum protein is >0.5
  2. pleural fluid LDH/serum LDH is >0.6
  3. pleural fluid LDH more than two-thirds the normal upper limit for serum LD
• Pleural transudates occur in the setting of normal capillary integrity (membrane intact)
• A transudate suggests the absence of local pleural disease

  • characteristic laboratory findings include:
  • pleural glucose equal to serum glucose
  • pH between 7.40 and 7.55
  • fewer than 1000 white blood cells/mcL - mostly mononuclear cells.
• Pneumothorax - presence of air in the pleural cavity
• Pneumothorax symptoms

  • SOB
  • tachypnea
  • cyanosis
• Pneumothorax PE

  • hyper resonant
  • lagging on chest expansion
  • decrease diaphragmatic excursion
  • decrease breath sound
  • decrease tactile fremitus and bronchophony
• Primary spontaneous pneumothorax

  • no lung pathology
  • due to ruptured apical bleb
• Primary Spontaneous Pneumothorax - risk factors

  • young male
  • thin and tall
  • family hx
• Primary Spontaneous Pneumothorax - need needle aspiration for initial episode

  • if it recurs do - thoracoscopy with stapling of bleb and pleural abrasion
• Secondary pneumothorax

  • due to underlying lung pathology - COPD
  • life threatening due to poor respiratory reserve
• Secondary pneumothorax

  • requires CTT placement
  • most would need - thoracostomy with pleural abrasion
  • if not operational - pleurodesis
• Traumatic pneumothorax due to trauma - penetrating
• Traumatic pneumothorax

  • mediastinal structures pushed aside leading to hypotension with distended jugular veins
  • crisps heart sound
• Traumatic pneumothorax - stable pts

  • CXR
  • observe for 24 hrs then do another CXR
• Traumatic pneumothorax - severe

  • place a CTT
  • remove if bubbling is no longer seen
• Traumatic pneumothorax - unstable

  • CTT immediately
• Tension pneumothorax - occurs during mechanical ventilation or resuscitative effects
• Tension pneumothorax

  • if ventilated, suspicion is increased if hemithorax is enlarged but without breath sound
  • hyper resonant
• Tension Pneumothorax - stable pts

  • CTT and CXR
  • initial needle decompression at anterior 2nd intercostal space