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Questions and Answers
What is the primary characteristic of pyothorax?
What is the primary characteristic of pyothorax?
Which of the following can be a cause of chylothorax?
Which of the following can be a cause of chylothorax?
What is a potential treatment option for pneumothorax?
What is a potential treatment option for pneumothorax?
Which of the following conditions is characterized by milky effusion?
Which of the following conditions is characterized by milky effusion?
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What is a likely cause of haemothorax?
What is a likely cause of haemothorax?
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In the treatment of pyothorax, what is a crucial step after determining the diagnosis?
In the treatment of pyothorax, what is a crucial step after determining the diagnosis?
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What diagnostic step is necessary for managing haemothorax?
What diagnostic step is necessary for managing haemothorax?
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What is a common reason for pneumothorax in pets?
What is a common reason for pneumothorax in pets?
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What is a primary indication for placing a thoracostomy tube?
What is a primary indication for placing a thoracostomy tube?
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Which of the following is NOT part of patient preparation for thoracostomy tube placement?
Which of the following is NOT part of patient preparation for thoracostomy tube placement?
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What is a key consideration during the management of a thoracostomy tube?
What is a key consideration during the management of a thoracostomy tube?
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What is the primary purpose of thoracocentesis?
What is the primary purpose of thoracocentesis?
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Which clinical sign is indicative of a diaphragmatic hernia?
Which clinical sign is indicative of a diaphragmatic hernia?
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What site is targeted for thoracocentesis in the pleural space?
What site is targeted for thoracocentesis in the pleural space?
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What is the expected management step for a patient with flail chest?
What is the expected management step for a patient with flail chest?
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What is essential to ensure before performing thoracocentesis?
What is essential to ensure before performing thoracocentesis?
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Which of the following is a common complication associated with thoracic bite wounds?
Which of the following is a common complication associated with thoracic bite wounds?
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What should be done when fluid production from a thoracostomy tube reduces to 2-4ml/kg/day?
What should be done when fluid production from a thoracostomy tube reduces to 2-4ml/kg/day?
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Which of the following is NOT a diagnostic tool mentioned for the pleural space assessment?
Which of the following is NOT a diagnostic tool mentioned for the pleural space assessment?
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In the event of a diaphragmatic hernia, what is a critical procedure that must be performed upon closure?
In the event of a diaphragmatic hernia, what is a critical procedure that must be performed upon closure?
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Which of the following steps is crucial when preparing the site for thoracocentesis?
Which of the following steps is crucial when preparing the site for thoracocentesis?
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Why is it important to monitor respiratory rate in a dyspnoeic patient?
Why is it important to monitor respiratory rate in a dyspnoeic patient?
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What characteristic of pleural fluid should be assessed during fluid analysis?
What characteristic of pleural fluid should be assessed during fluid analysis?
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What is advised when approaching a dyspnoeic patient during the initial examination?
What is advised when approaching a dyspnoeic patient during the initial examination?
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Study Notes
Diseases of the Pleural Space and Chest Wall
- This presentation covers diseases affecting the pleural space and chest wall.
- Learning outcomes include describing pathological issues, diagnostic procedures/therapeutics, and management of these disorders.
What is the Pleural Space?
- The pleural cavity is a potential space between the chest wall, lungs, diaphragm, and mediastinum.
Approach to the Dyspnoeic Patient
- Minimise stress during examination, working quickly.
- Initial treatment includes oxygen therapy, intravenous access, pain relief (e.g., butorphanol), and potentially thoracocentesis.
- Stabilise the patient before extensive diagnostics.
Diagnostics
- Diagnostic Imaging: X-rays are used. Several views might be taken.
- Diagnostic Echocardiography (TFAST): This ultrasound technique targets specific sites (e.g., chest tube site, pericardial site, diaphragmaticohepatic view).
- Thoracocentesis: This procedure removes fluid or air from the pleural space. It might be diagnostic or therapeutic. Equipment includes a butterfly needle, three-way tap, syringe, and measuring bowl. Patient preparation involves sternal recumbency, sterile technique, shaving a 15cm radius area and aseptic preparation.
Thoracocentesis - Fluid Analysis
- Fluid analysis determines if it's a transudate or exudate based on protein and cell count.
- The specific classification of the fluid could be used for diagnosis.
- Pyothorax or FIP can be diagnosed from fluid characteristics alone.
Differentials for Pleural Space Disease
- Pneumothorax: Caused by air in the pleural space, often from respiratory tract, oesophagus, or penetrating wounds/trauma. Types include closed, open, and tension pneumothorax. Treatment involves thoracocentesis, thoracotomy tube, pain relief, oxygen, and possibly antibiotics if trauma.
- Hemothorax: Blood in the pleural space. Causes include trauma, coagulopathy, or neoplasia. Further diagnostics are needed to determine the underlying cause. Treatment includes treating hypothermia/hypovolemia, blood transfusions, and pain relief.
- Chylothorax: Milky pleural fluid with high triglyceride count. Causes include idiopathic cases, traumatic duct rupture, lung lobe torsion, mediastinal masses, or heart disease. Treatment involves thoracocentesis, addressing underlying causes, and possible low fat diets.
- Pyothorax: Purulent fluid in the pleural space. Causes include foreign bodies (like grass seeds), bite wounds or pneumonia. Diagnosis involves evaluating the appearance and smell of the fluid and looking for neutrophils and intracellular bacteria. Treatment includes thoracic drainage (thoracostomy tube), lavage, surgical foreign body removal, and antibiotics, potentially with a guarded prognosis.
Thoracotomy Tube
- This tube is used for frequent pleural drainage, for medical management of pyothorax, or after thoracic surgery. Preparation includes pre-oxygenating the patient and using local or general anaesthesia.
Diaphragmatic Hernia
- Organs shift into the thoracic cavity.
- Clinical signs include dyspnoea, muffled heart/lung sounds, and an abnormal empty abdomen during palpation.
- Treatment involves stabilising the patient followed by surgery, likely with an abdominal approach. Intubation and pneumothorax drainage may be required post-operative.
Differentials for Chest Wall Injury
- Injuries include trauma, flail chest, open pneumothorax, penetrating trauma, and bite wounds.
Flail Chest
- A freely moving section of chest wall due to multiple consecutive rib fractures.
- Clinical signs include tachypnoea, dyspnoea, thoracic pain, and paradoxical movement of the affected segment (inhalation/exhalation).
- Treatment involves emergency stabilisation, chest banding, aggressive pain management, and potentially surgical stabilisation.
Dog Bites
- Thorax is a common site for dog bites.
- Potential complications include rib fractures, lung laceration, intercostal muscle avulsion, crush injuries and bacterial inoculation.
- Treatment involves surgical exploration, wound flushing, and pain relief. Antibiotics are part of the approach.
Summary
- A logical and controlled approach to animals with compromised breathing is advised.
- Thoracocentesis is a valuable diagnostic and therapeutic approach
- Ultrasounds are crucial tools for diagnosing pleural fluid and chest wall masses.
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Description
This quiz explores various diseases affecting the pleural space and chest wall, including their pathology, diagnostic procedures, and therapeutic management. Learn how to approach dyspnoeic patients and understand important diagnostic techniques such as imaging and thoracocentesis.
