Case 1 Shortness of breath and a cough
p 1 Case 1 Shortness of breath and a cough
64yr , history CA R breast , lumpect , chemo , non-productive cough 4day, O2sat 92
p 2 film large rt plural effusion – เรียกว่า white-out appearance
mediastinum shift
plural tap or thoracocentesis under usg – safe triangle area
– mid-axillary line
– lateral border to pectoris major
– supr to horizontal level of nipple ,
– apex below axilla
4 type of fluid in pleural space – bl , serous fluid(hydrothorax) , chyle(chylothorax) , pus(empyema)
effusion – ได้ทั้งtransudates , exudate – ขึ้นกับ prot , lactate dehydrogenas(LDH)
**Transudate – systemic condition eg alter balance pleural fluid production and resorption – heart failure , renal failure, cirrhosis
– lower level prot and LDH
**Exudate – มักจะบอก local condition – bac , malignant , higher prot and LDH
, cytoplasm , c/s
tap release , O2 canular