Pleural effusion- Make sure you do serum LDH and protein as well as a diagnostic tap
- Need to calculate ratios
- Serum values may well be low
- Draining fluid too quickly can cause re-expansion pulmonary oedema
- Drain 1 litre at a time, then clamp and rest for an hour
- Types of effusion
- Serous fluid (hydrothorax)
- Blood (haemothorax)
- Chyle (chylothorax)
- White/milky appearance
- Leakage from blocked thoracic duct
- Lymphoma / Iatrogenic
- Pus (empyema)
BTS asthma guidelines
COPD - GOLD guidelines (see PDF below)
- Most important info on TTO, to guide A+E at next admission:
- ABG when well (e.g. CO2 of 10 may be fine)
- Treatment ceiling
- Subdued breath sounds
- Only ever give steroids for an exacerbation under antibiotic cover
- 28% venturi mask
- Prognosis:
- B - BMI
- O - Obstruction
- D - Dyspnoea
- E - Exercise tolderance
- Only ever give oral steroids as maintenance therapy together with inhalers
- Surgical treatments:
- Lung transplant
- Volume reduction therapy
Bronchitis - Archaic term
- Definition:
- 3 months of cough + white sputum
- For 2 consecutive years
BODE Index
| Variable | Points on BODE Index | | | 0 | 1 | 2 | 3 | | FEV1 (% predicted) | ≥65 | 50-64 | 36-49 | ≤35 | | 6-Minute Walk Test (meters) | ≥350 | 250-349 | 150-249 | ≤149 | | MMRC Dyspnea Scale | 0-1 | 2 | 3 | 4 | | Body Mass Index | >21 | ≤21 |
MRC Dyspnoea Scale
| 0 | Breathless only with strenuous exercise | | 1 | Short of breath when hurrying on the level or walking up a slight hill | | 2 | Slower than most people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level | | 3 | Stop for breath after walking about 100 meters or after a few minutes at my own pace on the level | | 4 | Too breathless to leave the house or I am breathless when dressing |
Pneumothorax- Ehlers–Danlos syndrome (EDS)
- Group of inherited connective tissue disorders, caused by a defect in the synthesis of collagen (Type I or III)
- Predisposes to spontaneous pneumothorax
- As does Marfan's
- BTS classification
- Primary
- Small (<2 cm) => Conservative management
- Large (>2 cm) => Aspirate with syringe
- Secondary
- Small (<2 cm) => Aspirate with syringe, Chest drain if required
- Large (>2 cm) => Chest drain
Notes - Laryngeal oedema => Higher -ve pressures in lung => Pulmonary oedema after extubation
- Pleurodesis - Deliberately inflame the pleura, so they stick together
- Less than 3-4 fingerbreadths between suprasternal notch and cricothyroid cartilage
- 2 cm pneumothorax (BTS "Small") is equivalent to 50% volume loss
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 Updating... Ċ Kieran Gillick, 21 Dec 2012, 10:33
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