Pleural Effusions - Dr. Graboyes

Pathophysiology
Based on 2 concepts
    - Increased hydrostatic pressure
    - Decreased oncotic pressure

CXR
- Upright films will detect effusions >400mL
- Lateral decubitus films will detect as little as 50mL of fluid

Fluid analysis
- Order: cell count, gram stain, culture, pH, protein, LDH

Exudate vs transudate - use Light's Criteria

    Transudates:
            CHF
            Nephritis
            Nephrotic syndrome

    Exudates:
            Infection
            Traumatic HTX
            Malignancy
            CT disorders

Management:

- Treat the underlying pathology!
- Avoid large volume taps (>1L) if CHF, renal or hepatic pathology
- Unstable - septic shock, tension hydropneumothorax

- If tapping:
    - Avoid NV bundle
    - Have patient lean over table
    - Use ultrasound

- When to tap:
    - Typically, these patients will not need a tap or tube in the ED.
    - If patients have persistent hypoxia in spite of other interventions, consider tap.
    - Severe respiratory failure.

Complications:
PTX
Infection
Hemorrhage
Rare - air embolism, sheared catheter loss

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