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DEFINITION
Pleural
mechanisms:
increased permeability of the pleural membrane
increased pulmonary capillarpressure
decreased negative intrapleural pressure
decreased oncotic pressure
Obstructed lymphatic flow
Exudative
Lights criteria
Rare causes
Constrictive pericarditis
Urinothorax
Superior vena cava obstruction
Ovarian hyperstimulation
Meigs syndrome
Malignancy
Parapneumonic effusions
Less common causes
Pulmonary infarction
Rheumatoid arthritis
Autoimmune diseases
Benign asbestos effusion
Pancreatitis
Post-myocardial infarction syndrome
Rare causes
Yellow nail syndrome
Drugs
Fungal infections
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DIAGNOSTIC (1)
History taking and physical examination
Fluid < 300 cc, The symptom is disappear
The fluid >300 cc, The symptom are decreasing movement
of hemithoraks, stem fremitus and breath sound decrease,
or disappear.
Pleural fluid > 1000 cc can cause the chest more convex
than contralateral, auscultation egophoni
The fluid >2000 cc push the mediastinum to the normal
site
DIAGNOSTIC (2)
Plain radiography
PA and lateral chest radiographs should be performed
Ultrasound findings
Ultrasound guided pleural aspiration should be used as
CT Scan
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DIAGNOSTIC (2)
A diagnostic pleural fluid sample should be gathered
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DIFFERENTIAL DIAGNOSIS
Lung Tumor
Swarte/Tickening of pleura
Atelectasis inferior lobe
High level potition of diaphragma
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COMPLICATION
Complication of pleural effusion depend on
underlying desease :
Empiema
Swarte
Respiratory failure
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Management
The management of pleural effusion depend on
management of underlying desease and
thoracocentesis.
Thoracocentesis indication:
Release of Shortnes of breath that caused by fluid
accumulation
Diagnosis with examine the pleural fluid
continued..
Lack of thoracocentesis:
Thorakosentesis can cause lost of protein
Infection (empyema)
Pneumothoraks
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EMPYEMA (1)
Definition:
Presence of pus in the pleural space
Causes:
Direct extension of a pulmonary parenchymal infection
into pleural space
Post surgical infection
Trauma
From abdominal infection (ex: subdiaphragmatic
abscess)
Complication of thoracosinthesis or pleural biopsy
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EMPYEMA (2)
Symtoms
Usually non specific
80% : dyspnea and fever
70% : cough and chest pain
Constitusional complaint : weight loss, fatigue, malaise
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THERAPY
Appropriate antibiotic therapy
Initial choice of antibiotic depends on clinical setting
and should be guideed by the result of the gram stain of
pleural fluid and sputum
Adequate pleural drainage
Chest tube placement (WSD)
Thoracosintesis
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HEMOTHORAX
Definition:
Presence of significant amount of blood in the pleural
space
Causes:
Most comman: trauma (penetrating or penetrating)
Occasionally iatrogenic prosedure
Uncomman: malignancy, during unticoagulant therapy
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CHYLOTHORAX
True chylous effusions result from disruption of the
must
be
distinguished
from
pseudochylothorax or cholesterol pleurisy which
results from the accumulation of cholesterol crystals in
a long standing pleural effusion
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Pseudochylothorax
Neoplasm: lymphoma,
metastatic carcinoma
Trauma: operative,
penetrating injuries
Miscellaneous: tuberculosis,
sarcoidosis,
lymphangioleiomyomatosis,
cirrhosis, obstruction of
central veins, amyloidosis
Tuberculosis
Rheumatoid arthritis
Poorly treated empyema
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PNEUMOTHORAX
Pneumothorax is defined as air in the pleural
space.
Classification:
Based on occurrence:
Arrtificial
Traumatic
Spontaneous
SPONTANEOUS PNEUMOTHORAX
Primary pneumothorax
arise in otherwise healthy people without any lung
disease.
subpleural blebs and bullae are likely to play a role in the
pathogenesis since they are found in up to 90% of cases
of primary pneumothorax at thoracoscopy or
thoracotomy and in up to 80% of cases on CT scanning
Secondary pneumothotax
pneumothoraces arise in subjects with underlying lung
disease
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SECONDARY PNEUMOTHORAX
More serious than spontaneous primary pneumothorax,
Lung tumor
Tuberculosis
Other pulmonary infection
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DIAGNOSTIC TUMOR
COLLAPS TREATMENT IN
LUNG TUBERCULOSIS
OPEN PNEUMOTHORAX
Is pneumothorax that there is connection between pleural
+2
Inspiration -2
NORMAL:
Expiration -4
Inspiration -8
30 minutes
+2
-2
-9 cm H2O
-12 cm H2O
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CLOSED PNEUMOTHORAX
pneumothorax that there is no connection between
-4
Inspiration -12
30 minutes
-4
-12
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VENTIL PNEUMOTHORAX
Tension pneumothorax occurs because the opening that
+2
Inspiration -12
30 min
-4
-12
30 min +10
+6
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Anxiety
Acute epigastric pain (a rare finding)
Fatigue
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Inspection Static
Widening ICS
Dinamic
Palpation Stem fremitus
Percution
HS
HS
HS
N
N
N
V V
V V
V V
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Lab: BGA
Chest radiography
USG
CT Scan
Proef puncture
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DIFFERENTIAL DIAGNOSIS
PNEUMOTHORAX
Emphysematous lung
Asthma bronchiale
Giant bullae
Acute Myocard Infarction
Hernia diaphragmatica
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COMPLICATION OF
PNEUMOTHORAX
Pleural effusion
Emphysema subcutis
Syock cardiogenic
Respiratory distress
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INSPIRA
EKSPIRASI
SI
PNEUMOTHORAX SPONTANEA
VENTIL
SAAT EKSPIRASI TEKANAN SEMAKIN MENINGKAT
MATI OLEH KARENA:
MEDIASTINUM TERDORONG KE SISI YANG SEHAT
GAGAL KARDIOVASKULER DAN GAGAL NAPAS
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1. pneumothorax traumatica
2. pneumothorax spontanea
1
1
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PNEUMOTHORAX
PENDORONGAN MEDIASTINUM
HEMITHORAX CEMBUNG & GERAK RESPIRASI TERTINGGAL
PARU KOLAPS & MEDIASTINUM TERDESAK UDARA KEARAH SISI YANG SEHAT
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djois
PNEUMOTHORAX VENTIL
djois
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1hemithorax
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TREATMENT OF PNEUMOTHORAX
Primary spontaneous pneumothorax
Observation
Oxigen suplementation
Gas absorbtion will exceed
Simple aspiration
Tube thoracostomy
Thoracoscopy VATS
Pleurodesis
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ALAT KONTRA
VENTIL
WSD
WSD
udara
UDARA DALAM
CAVUM PLEURAE
KELUAR
TIP :
+10 cmH2O
+20 cmH2O
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djois
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Lokasi:
ICS
IC
ICS
VII/VIII
II/III
IV/V
P.A.L
M.C.L: Cara Monaldi
M.A.L: Cara Buelau
Persiapan Alat:
Klem desinf, duk
Kasa, duk berlubang
Madrin, kanul
Gunting, pinset
Jarum jahit, benang
Spuit, anestesi
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PLEURODESIS
Pleurodesis is a medical procedure in which the
Indication:
recurrent pneumothorax
recurrent pleural effusion/ Malignant pleural effusion
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CHEMICAL PLEURODESIS
Chemicals such as:
bleomycin
tetracycline
povidon iodine
Slurry of talc
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