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Depending on chronicity, treat by lung reexpansion. Thoracotomy with decortication sometimes required in infectious cases HEPATOHYDROTHORAX—suspect if cirrhosis and portal hypertension, even in the absence of ascites. Pleural effusion results from passage of peritoneal fluid into pleura because of negative intrathoracic pressures and diaphragmatic defects. Do not insert chest tube. 03% 2 sprays/nostril BID–TID, nasal corticosteroids, nasal saline rinses BID), surgical correction for anatomical abnormalities findings; consider sinus imaging TREATMENTS —reduce irritant exposure, antihistamine- decongestant combinations (diphenhydramine 25–50 mg PO q4–6 h PRN, · Hemoptysis DIFFERENTIAL DIAGNOSIS NONC ARDIOPULMONARY —epistaxis, upper GI bleed, coagulopathy CARDIAC—HF, mitral stenosis PULMONARY · AIRWAY —bronchitis (acute, chronic), bronchiectasis, malignancy, foreign body, trauma · PARENCHYMA · MALIGNANCY—lung cancer, metastasis INFECTIONS —necrotizing pneumonia (Staphylococcus, Pseudomonas), abscess, septic emboli, TB, fungal · ALVEOLAR HEMORRHAGE—granulomatosis with polyangiitis (Wegener's), Churg– Strauss, Goodpasture disease, pulmonary capillaritis, connective tissue disease VASCULAR—pulmonary embolism, pulmonary hypertension, AVM, iatrogenic · · PATHOPHYSIOLOGY MASSIVE HEMOPTYSIS—100–600 mL blood in 24 h.
Best for interstitial lung disease LUNG CANCER PROTOCOL—7–10 mm cut of entire chest. Also scans adrenals and liver. Contrast enhanced. Best for nodules and mediastinal and pleural structures PULMONARY EMBOLISM PROTOCOL — contrast bolus timed for optimal imaging of pulmonary arteries. 16) Approach to Pulmonary Function Tests TERMINOLOGIES DLCO—carbon monoxide diffusion capacity FEF2575%—forced expiratory flow during the middle of an FVC maneuver, represents flow of small airways FLOWVOLUME LOOP PATTERNS NORMAL Expiration CLASSIFICATION OF PULMONARY DISEASES OBSTRUCTIVE—asthma, COPD, bronchiectasis, cystic fibrosis, bronchiolitis obliterans RESTRICTIVE PARENCHYMAL—sarcoidosis, idiopathic pulmonary fibrosis, pneumoconiosis, other interstitial lung diseases EXTRAPARENCHYMAL—neuromuscular (diaphragmatic paralysis, myasthenia gravis, Guillain–Barré syndrome, muscular dystrophies), chest wall (kyphoscoliosis, obesity, ankylosing spondylitis) TERMINOLOGIES CONT’D FEV1—forced expiratory volume during the first second of an FVC maneuver FVC—forced vital capacity, maximum volume exhaled after maximum inhalation MEP—maximum expiratory pressure MIP—maximum inspiratory pressure TLC—total lung capacity at maximal inhalation Flow Inspiration OVERALL APPROACH TO PFT INTERPRETATION 1.
US-guided thoracentesis is standard of care. ]) and/or HF suspected, start with diuresis for 2–3 days. 3 mmol/L [<60 mg/dL])—parapneumonic, TB, paragonimiasis, malignancy, rheumatoid arthritis, Churg–Strauss, hemothorax · FLUID EOSINOPHILIA (>10%)—paragonimiasis, malignancy, Churg–Strauss, asbestos, drug reaction, pulmonary embolism, hemothorax, pneumothorax, idiopathic (20%) · CYTOLOGY FOR MALIGNANCY—the yield for diagnosis with single attempt is 60%, two attempts is 85%, three attempts is 90–95%; obtain as much fluid as possible to increase diagnostic yield · FLUID FOR AFB—obtain as much fluid as possible and ask laboratory to centrifuge collection and to culture sediment to increase diagnostic yield MANAGEMENT SYMPTOM CONTROL—O2, diuresis (furosemide), drainage (thoracentesis, pigtail catheter, PleurX catheter, chest tube), pleurodesis (talc slurry or poudrage), surgery (talc slurry, pleuroperitoneal shunt, pleural abrasion, pleurectomy) TREAT UNDERLYING CAUSE SPECIFIC ENTITIES PARAPNEUMONIC EFFUSION · UNCOMPLICATED—exudative effusion that resolves with resolution of pneumonia.