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