Pleural Effusion

Question 1

Define pleural effusion

• normal amount of fluid?

Answer 1

Fluid in the pleural space

• normal physiological amount of fluid in the pleural space is 10-20mls

Question 2

When do pleural effusions manifest?

Answer 2

formation of pleural fluid is excessive or when fluid resorption is disturbed

Question 3

Which type of pleural effusion does the pleura remain intact?
- transudative vs exudative?

Answer 3

Transudative pleural effusion

Question 4

3 complications of transudative pleural effusions?

Answer 4

CHF (most common)

Liver cirrhosis

Nephrotic syndrome

Question 5

Exudative pleural effusions have what?

• causes?

Answer 5

High protein content; they’re acidic in nature

• caused by infection/inflammation -> leak = increased permeability

Question 6

In the realm of pleural effusions, what happens during CHF?

Answer 6

Most common indicator of pleural effusions

There is increased hydrostatic pressure
- Transudative pleural effusion

Question 7

In the realm of pleural effusions, what happens during liver cirrhosis?

Answer 7

There is reduced ontoctic pressure due to reduced production of albumin
- transudative pleural effusion

Question 8

In the realm of pleural effusions, what happens during nephrotic syndrome

Answer 8

Reduced oncotic pressure due to increased elimination of proteins
- transudative pleural effusion

Question 9

3 complications of exudative pleural effusions?

Answer 9

Localized ruptures of blood/lymphatic vessels, lung abscess or esophagus

• Increased permeability
• infections
• Malignant effusions and mesothelioma

Question 10

What do Empyema, chylothorax and hemothorax have in common?

Answer 10

Different pathologic fluid conditions that separate the parietal form from the visceral pleura.

Question 11

Clinical manifestations of pleural effusion?

Answer 11

Any condition that compresses the lung and in turn probably the heart. so..

• tachycardia and tachypnea
• hypertension
• pleuritic chest pain
• diminished or absent breath sounds
• pleural rub

(are some examples but not all)

Question 12

resp and metabolic acidosis are accosiated with which type of pleural effusion?

Answer 12

exudative effusions.

• also resp failure after compensation failure

Question 13

CxR findings for a pleural effusion?

Answer 13

Blunted costophrenic angle
fluid level on the affected side/meniscus sign
depressed diaphragm
mediantinal shift to unafffected side
atelectasis

Question 14

minimum range to see a pleural effusion on a CxR?

Answer 14

200-300 ml

• Lateral decubitus (Pt on their side) can be recognized w//50 mls
• other scans (CT, Ultrsound,MRI) require 100 mls or more

Question 15

What is it called when pleural effusions are drained?

Answer 15

Thoracentesis

Question 16

Treatment options/game plan for pleural effusions?

Answer 16

1. Treat hypoxemia w/oxygen therapy
2. Treat symptoms like pain/dyspnea
3. treat underlying cause
4. Thoracentesis
5. pleurodesis for malignant pleural effusion

Question 17

Morphine can be used to assist with which 2 symptoms?

Answer 17

Serves as a analgesic and can reduce respiratory drive.

• for dyspneic pts, it can reduce their resp. drive.

Question 18

What is pleurodesis?

Answer 18

permanent removal of pleural fluid w/the use of in dwelling pleural catheter

Question 19

When treating a pt’s hypoxemia w/O2 therapy, what should you use to guide your therapy?

Answer 19

ABG/VBG to guide oxygen and vent management.

Question 20

Pleurodesis vs. drainage?

Answer 20

Pleurodesis is the permanent removal of pleural fluid w/the use of i dwelling pleural catheter. more invasive = treatment -> goal is to separate parietal and visceral form to prevent accumulation of fluids

drainage = poking with a needle = therapeutic procedure

Question 21

what establishes the prescience of a pleural effusion?

Answer 21

Thoracentesis?

(thoracic drainage)

Question 22

What are the 5 aims of Tx for pleural effusions?

Answer 22

1. treat symptoms like pain and dyspnea (analgesics)
2. Treat the underlying cause (antibiotics)
3. Thoracentesis
4. Pleurodesis for malignant pleural effusions
5. Treat hypoxemia w/appropriate O2 therapy.