Use of "pleural effusion" for differential

[OVeractiveBrain]

As I understand it, a chest X-ray 'positive for plerual effusion' without further evaluation of the fluid is quite useless. All it says is "yes, you have fluid in your pleural space." Using it to differentiate a worsening CHF or a new pneumonia is useless. Often times the nurse (as in always) will not know whether the fluid is determined as Transudate or Exudate, let alone whether it has been confirmed as serum plasma or gram positive. Can we use the information of "has a pleural effusion" or "has had pleural effusions" without further information of the effusion to form a clinical impression in the field? I understand that all differentials come from a combination of sources, but i am looking for a useful (or be told its not) way to use the information of plueral effusion in forming a clinical impression and choosing a therapy.

OveractiveBrain

[ERDoc]

Pleural effusion is a diagnosis on it's own. There are many reasons to have them; the ones you mentioned, a lung mass as well as many others. From your standpoint there is not much you need to know about an effusion other than it is there. The same is true in the ER. They are only clinically significant when they get to be big enough to cause resp distress, even then there is not much for you to do in the field. In the ER we can tap them if needed, but we generally don't. From an emergency standpoint it does not matter whether it is a transudate or exudate. I don't think you truly understand what gram positive means based on your post.

[chbare]

A pleural effusion can be caused by a multitude of problems. In most patients, a pleural effusion is a result of their underlying problem/s. I know of only a few cases where we actually performed a thoracentesis of a pleural effusion in the ER. They were very large and the procedure was performed to ease the work of breathing and enhance gas exchange. So, I would say, focus on the patient as a whole and realize that some findings can be related to more complex underlying problems. In addition, you have more than just G+ organisms to worry about when dealing with infection.

Take care,

chbare.

[Ridryder 911]

Unfortunately, I have personal experience regarding pleural effusions. Many leading cancer and thoracic research physicians forewarn "tapping" pleural effusions. (check out MD Anderson web site for more info) Studies have indicated irritation of cells may increase cell development.

My significant other had a pleural effusion of approximately 2 liters before "tapping" thoracentesis occurred. We knew the source and problems, finally a thoracotomy had to be performed because a rhine developed over the lung tissue & prevented needle tap. Talc powder was introduced into thoracic cavity to help eliminate re-occurring effusion, which appeared to work some. Effusion re-occurred, but at a slower rate.

I do make a suggestion of different views are needed in x-ray for more clarity, such as swimmers, etc. to detect level until CT can be performed.

R/r 911

[Dustdevil]

I don't think you truly understand what gram positive means based on your post.

Surely you jest!

Everybody knows you can't become a paramedic without passing college microbiology!

Hey, where's that internet place where I can get my RN without going to nursing school, since us paramedics already know more than an RN does?

[ERDoc]

Surely you jest!

Everybody knows you can't become a paramedic without passing college microbiology!

Hey, where's that internet place where I can get my RN without going to nursing school, since us paramedics already know more than an RN does?

I jest, and don't call me Shirley.

[Rezq304]

I jest, and don't call me Shirley.

Have we really come to alluding to Leslie Neilson & "Airplane"?!?!?!