Pleural effusion

Question 1

Airway

Answer 1

Question 2

Breathing

Answer 2

Look: increased work of breathing,
Listen: decreased breath sounds
Feel: stony dull percussion, chest expansion, tracheal deviation

RR - increased?
O2 - low

ABG
CXR portable
Sputum culture

Management
1. 15L O2 via NRB mask
2. Pleural fluid aspiration:
3. Chest drain

Aspiration:
- Clinical chemistry (protein, glucose, LDH, pH, amylase)
- MC&S, staining
- cytology
- immunology

APPLY LIGHTS criteria

Question 3

Circulation

Answer 3

Look: peripheral shutdown, diaphoresis
Listen: S1+S2+0
Feel: CRT, pulses

HR, BP
ECG

Bloods:
1. FBC, UEs, CRP, LFTs, blood cultures?
2. Clotting

Question 4

Disability

Answer 4

PEARL
BM
GCS
neuro exam

Question 5

Exposure

Answer 5

GI exam
calves
urine dip
obs

Question 6

LIGHTs criteria

Answer 6

Protein:
< 25 g/L - transudate
- increased venous pressure
- HF
- constrictive pericarditis
- fluid overlode
- cirhosis
- nephrotic syndrome
- Meig’s syndrome (ovarian fibroma)

If greater than 35 g/L - exudate
- increased leakiness of pleural capillaries because of increased IIM
- pneumonia TB, PE, SLE, mets

Question 7

Summary

Answer 7