Pleural Diseases: Treatment Overview

Study Notes

Pleural Diseases Treatment

Thoracocentesis:
- Primarily indicated for pleural effusion
- Fluid is removed via needle insertion above the 10th rib at the scapular line
- Requires strict aseptic conditions
- Potential complications include hemothorax, pneumothorax, neurogenic shock, and pulmonary edema
Intercostal Chest Tube:
- Used for managing pneumothorax (open, bilateral, or tension), empyema, and hemothorax
Tension Pneumothorax:
- Medical emergency necessitating immediate decompression with a wide-bore needle in the 2nd intercostal space
- Followed by the insertion of an intercostal chest tube
- Includes management with oxygen and analgesics

Bronchial Asthma

Definition and Aetiology:
- Characterized by bronchial narrowing due to bronchospasm, inflammatory infiltrate (eosinophils), and mucus plugs
- Can be triggered by allergies (extrinsic) or bronchial hyper-reactivity (intrinsic)
Clinical Picture:
- Patients often asymptomatic between attacks
- Attacks typically occurring at night or early morning
- Symptoms include wheezing, non-productive cough, dyspnea, and production of viscous sputum post-attack
- Signs include restricted respiratory movement, palpable rhonchi, hyper-resonant percussion notes, and harsh vesicular breathing
Complications:
- Respiratory: Status asthmaticus (severe asthma) and respiratory failure
- General: Treatment complications like diabetes and hypertension from steroids
- Chronic Cough: May lead to myositis, rib fractures, pneumothorax, hemoptysis, puffy eyelids, and hernia
Investigations:
- Sputum examination reveals eosinophilia
- Blood tests show increased eosinophils and raised serum IgE in extrinsic asthma
- Skin prick tests help identify triggers
- Chest X-ray may show hyperinflation
- Pulmonary function tests often show obstructive hypoventilation
Treatment:
- Quick relief: Inhaled short-acting beta-2 agonists (SABA) like Salbutamol
- Control medications: Inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), and leukotriene receptor antagonists
- For severe cases: oral or parenteral steroids and IgE monoclonal antibodies

Pneumonia

Clinical Picture:
- Common symptoms include fever, anorexia, headache, malaise, cough, dyspnea, and rusty sputum expectoration
- Signs during examination include limited respiratory movement on the affected side, increased tactile vocal fremitus, dullness on percussion, and bronchial breathing with crepitations on auscultation
Special Types of Pneumonia:
- Staphylococcal Pneumonia: Caused by Staph. aureus; treated with nafcillin or vancomycin
- Friedlander's Pneumonia: Caused by Klebsiella in immunocompromised; apical lung involvement treated with ceftriaxone
- Pneumocystis Pneumonia: Caused by Pneumocystis jiroveci in AIDS patients; treated with Septrin or pentamidine
- Mycoplasma Pneumonia: Common in children and young adults; diagnosed by cold agglutination tests and treated with macrolides
- Legionella Pneumonia: Caused by Legionella pneumophila; associated with contaminated water; diagnosed via urine antigen test and treated with macrolides
Viral Pneumonia:
- Atypical pneumonia attributed to influenza viruses (including H1N1, H5N1), CMV, EBV, RSV, measles, and coronaviruses (SARS).

Description

This quiz covers the treatment methods for pleural diseases, focusing on thoracocentesis and intercostal chest tube procedures. You'll learn about indications, techniques, and potential complications associated with these treatments. Ideal for students and professionals in medical fields.