A 38 yo white female had been admitted for severe RLL pneumonia. After 5 days she left AMA because she was not allowed to smoke. At this time there was a "spot" on her RLL. She later appeared at the doctor's office without an appointment and said something was very wrong. She had flu-like symptoms which was getting worse. She could only speak in short sentences and was unable to inhale deeply. She was transported immediately to the hospital. The woman appears malnourished, poor personal hygiene and has yellow tobacco stains around her fingers. She is in moderate to severe respiratory distress.
Data: BP 130/60, HR 112, RR 36 T 37.7, trachea slightly shifted to left, absent BS over RML and RLL
CXR: large right-sided pleural effusion, partially collapsed RML and RLL
What procedure needs to be done?
What test needs to be done following the procedure?
For the above case the diagnosis is pleural effusion with collapsed lung .pleural effusion is a condition wherein there is a collection of fluid in the pleural space caused due to heart failure or inflammation like pneumonia or tuberculosis.
The treatment options are to start on antibiotics,diuretics ,pleural tapping,intercostal chest drainage
Thoracocentesis or Pleural tapping is an invasive procedure in which the excess pleural fluid is drained using a needle .the procedure can be done at bedside by a medical practitioner.PT,PTT,INR or coagulation profile should be assessed prior to the procedure to anticipate the risk of bleeding during and post procedure.A hollow needle is placed into the midaxillary line of 9th or 10th intercostal space the procedure is guided by an ultrasound .and the fluid is drained out.the fluid can be send for diagnostic test like fluid analysis,microscopy to identify the cell counts ,ADA adenosine deaminase is a test to check the presence of ADA which could be suggestive of tuberculosis.,culture and sensitivity to check for organism,ZN staining to check for Acid fast Bacilli ,Gene xpert to check for Mytobacterium tuberculosis.fluid cytology to know the differential cell count,pleural fluid LDH and Glucose ratio
Placement of intercostal drainage bottles also can drain pleural fluid slowly and gradually.
A 38 yo white female had been admitted for severe RLL pneumonia. After 5 days she...
A 38 yo white female had been admitted for severe RLL pneumonia. After 5 days she left AMA because she was not allowed to smoke. At this time there was a "spot" on her RLL. She later appeared at the doctor's office without an appointment and said something was very wrong. She had flu-like symptoms which was getting worse. She could only speak in short sentences and was unable to inhale deeply. She was transported immediately to the hospital. The...
A 38 yo white female had been admitted for severe RLL pneumonia. After 5 days she left AMA because she was not allowed to smoke. At this time there was a "spot" on her RLL. She later appeared at the doctor's office without an appointment and said something was very wrong. She had flu-like symptoms which was getting worse. She could only speak in short sentences and was unable to inhale deeply. She was transported immediately to the hospital. The...
A 38 yowf had been admitted for severe RLL pneumonia. After 5 days she left AMA because she was not allowed to smoke. At this time there was a "spot" on her RLL. She later appeared at the doctor's office without an appointment and said something was very wrong. She had flu-like symptoms which was getting worse. She could only speak in short sentences and was unable to inhale deeply. She was transported immediately to the hospital. The woman appears...
Health Record Face Sheet Record Number: 79-50-77 Age: 36 Gender: Female Length of Stay: 5 Days Service Type: Inpatient Discharge Status: To Home Diagnosis/Procedure: Insulin reaction Renal failure Diabetes Mellitus, Type II, long term insulin dependence Permanent catheter right internal jugular Removal peritoneal dialysis catheter DISCHARGE SUMMARY PATIENT: RAINEY INPATIENT RECORD NUMBER: 79-50-77 ADMITTED: 12-19-XX DISCHARGED: 12-24-XX PHYSICIAN: DR. ALEX, M.D. DISCHARGE DIAGNOSES: 1. Insulin reaction. 2. Renal failure. 3. Diabetes mellitus, Type II. OPERATIONS/ PROCEDURES: 1. Permanent catheter right...