Síguenos en Twitter     Síguenos en Facebook     Síguenos en YouTube     Siguenos en Linkedin     Correo Salutsantjoan     Gmail     Dropbox     Instagram     Google Drive     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon


My photo
FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, February 10, 2020

Pleural effusions

emDocs - February 10, 2020 - Authors: Peta N and Avila J
Reviewed by: Montrief T; Koyfman A; Long B
  • A diagnostic thoracentesis can be performed in patients with new pleural effusions or in patients with known but worsening pleural effusions.
  • A therapeutic thoracentesis should be performed in unstable patients, patients with complicated parapneumonic effusions, or in patients with empyemas.
  • Listen to your patients during the thoracentesis; if they complain of chest discomfort or worsening dyspnea… stop the procedure.
  • Typically, you should not drain more than 1 liter of fluid. Draining more than 1 liter of fluid can cause re-expansion pulmonary edema (patient becomes unstable and has frothy sputum).
  • Your patient develops a cough during the thoracentesis. Should you be worried? Not really. This cough is probably a sign of physiologic lung re-expansion or pleural irritation from the tube.
Take Home Points
  • There are a lot of causes for pleural effusions, but CHF is the most common precipitant seen in patients with bilateral pleural effusions. Malignancy is the most common cause of unilateral pleural effusions.
  • You may not be able see a pleural effusion on a CXR unless there is at least 175mL of fluid present.
  • If the effusion’s fluid is > 1.5cm in thickness (from parietal to visceral pleura) and covers at least 3 rib spaces, then it may be safe to tap.
  • A great guide on thoracentesis, using ultrasound, can be found here: http://www.emdocs.net/ultrasound-guided-thoracentesis/
  • Use an ultrasound to locate the effusion and decrease the risk of bleeding complications and pneumothorax.
  • Patients with parapneumonic effusions or hemodynamic instability will need prompt initiation of antibiotics and a tube thoracostomy"