12.12.21 Teaching notes

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

    • cf Asthma

  • Surgical treatments:

    • Lung transplant

    • Volume reduction therapy

Bronchitis

• • Archaic term

  • Definition:

    • 3 months of cough + white sputum

    • For 2 consecutive years

BODE Index

MRC Dyspnoea Scale

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