doyoudig
Forum Guru
Topics: 144
Posts: 613
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Can u guys pls clear my doubts and confrim/correct
1. Is a Comlicated Parapneumonic Effusion the same as Empyema
(Ph < 7.2, Gluc < 60...)
2. Is this the correct order of Rx for Empyema
- 1st Ab's
- 2nd Drain
- 3rd Surgery -- If Complex, Loculated w/ Thick Rim
* Do we go straight to surgery if the empyema is Complex, Loculated w/ Thick Rim or do we still go thru all the Initial Steps 1st then surgery
Is Surgery Indicated b/c of recurrent Empyemas leading to a Complex, Loculated w/ Thick Rim??
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| ssrpk
Forum Fanatic
Topics: 154
Posts: 2,819
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yes if its detected while its complex and loculated especially with the thick rim, no need to wait any further because antibiotics won't penetrate that thick rim...
if its complicated parapneumoinic effusion it is empyema, and chest tube is warranted, ofcourse along with antibiotics, also if upon detection it has a loculated rim chest trube can be given as long as its not multiloculated or having a thick rim.
hope it helps, any more inputs are welcome
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| cirus
Forum Guru
Topics: 108
Posts: 740
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Parapneumonic Effusion:
Bacterial pneumonias are frequently associated with pleural effusions (as often as 50 % of the time) and when they become complicated, require drainage. Complicated parapneumonic effusions include empyema (the finding of gross pus in the pleural space), those with positive pleural fluid cultures or Gram stains, and those in which the microbiology is negative but the patient continues to show signs of infection with fever, severe pleuritic pain and leukocytosis. In this last category the pleural fluid usually shows high white blood cell counts with polymorphonuclear predominance, glucose <30 mg/dl, and high LDH (>500 units/dl). Parapneumonic effusions require drainage by tube thoracoscopy. The patient who has pneumonia with a small amount of pleural fluid present and is clinically responding to antibiotic therapy (now afebrile, no pleuritic pain, normal white blood cell count) does not require thoracentesis. By contrast, rapid accumulation of pleural fluid in a patient with pneumonia is an indication for immediate thoracentesis.
This is what I found on the internet so parapneumonic effusion is only empyema due to pneumonia..For what I know for the sake of the Board, Drainage is always the next step then, then fluid analysis & Gm stain, then Culture of both Pleural fluid & blood, Then Abs, 3rd gen cephal sp
all of these steps are done at the same time so ur not delaying giving Abs, but just putting order to the proced..
any other openion??
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