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\author{xkissmekatex (kissmekate)}
\pdfinfo{
  /Title (acnp-pulmonary-pleural.pdf)
  /Creator (Cheatography)
  /Author (xkissmekatex (kissmekate))
  /Subject (ACNP Pulmonary Pleural Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{ACNP Pulmonary Pleural Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{xkissmekatex (kissmekate)} via \textcolor{DarkBackground}{\uline{cheatography.com/33594/cs/10534/}}}
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  \vspace{-2pt}xkissmekatex (kissmekate) \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 16th January, 2017.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
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\begin{document}
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{x{1.74195 cm} x{3.23505 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pleural Effusion}}  \tn
% Row 0
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\seqsplit{Pathophysiology} & Caused by {\bf{increased drainage of fluid into the pleural space}}, increased production of fluid by cells in the pleural space, or decreased doing of fluid from the pleural space. \tn 
% Row Count 7 (+ 7)
% Row 1
\SetRowColor{white}
Causes & •  {\bf{CHF is most common cause}}. \{\{nl\}\}•  Bacterial pneumonia, malignancies (36\% of lung, 25\% of breast, 10\% of lymphoma), PE, viral diseases, and cirrhosis with ascites. \tn 
% Row Count 14 (+ 7)
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Symptoms & Often asymptomatic. {\bf{Dyspnea on exertion, peripheral edema, orthopnea, and PND}}. \tn 
% Row Count 18 (+ 4)
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Signs & {\bf{Dullness to percussion}}, decreased breath sounds, and decreased tactile fremitus. \tn 
% Row Count 22 (+ 4)
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Transudative Effusions & Pathophysiology is due to either {\bf{elevated capillary pressure in the visceral or parenteral pleura}} (as in CHF), or {\bf{decreased plasma oncotic pressure}} (hypoalbuminemia). \{\{nl\}\}•  Causes include CHF, cirrhosis, PE, nephrotic syndrome, peritoneal dialysis, {\bf{hypoalbuminemia}}, and atelectasis. \{\{nl\}\}•  pH is normally 7.4-7.55. \tn 
% Row Count 35 (+ 13)
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\begin{tabularx}{5.377cm}{x{1.74195 cm} x{3.23505 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pleural Effusion (cont)}}  \tn
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Exudative Effusions & Caused by {\bf{increased permeability}} of pleural surfaces or {\bf{decreased lymphatic flow}} from the pleural surface because of damage to pleural membranes or vasculature. \{\{nl\}\}•  Causes are {\bf{bacterial pneumonia}}, TB, malignancy, {\bf{metastatic disease}}, PE, viral infection, and collagen vascular diseases. \{\{nl\}\}•  Exudates must have \textgreater{}1 of the following. {\bf{Protein pleural/protein serum \textgreater{}0.5. LDH pleural/LDH serum \textgreater{}0.6. LDH\textgreater{} 2/3 upper limit of normal serum LDH}}. \{\{nl\}\}•  pH is 7.3-7.45. If \textless{}7.3, empyema, tumor, fibrosis. \tn 
% Row Count 21 (+ 21)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Empyema}}  \tn
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Causes & • Exudative pleural effusions left untreated can lead to empyema. \{\{nl\}\}• Most cases occur as a {\bf{complication of bacterial pneumonia}}, but other foci of infection can spread to the pleural space (mediastinhtis, abscess). \tn 
% Row Count 8 (+ 8)
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\seqsplit{Diagnosis} & CXR and CT \tn 
% Row Count 10 (+ 2)
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\seqsplit{Treatment} & • Aggressive drainage of the pleura via thoracentesis and antibiotic therapy. \{\{nl\}\}• Very difficult to eradicate and recurrence is common. \{\{nl\}\}• If severe and persistent, rib resection and open drainage may be necessary. \tn 
% Row Count 18 (+ 8)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Tests + Treatment}}  \tn
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CXR & • Look for {\bf{blunting of the costophrenic angle}}. \{\{nl\}\}•250mL must accumulate before an effusion can be detected. \{\{nl\}\}• Lateral decubitus films are more reliable for detecting small pleural effusions. \{\{nl\}\}• Can also determine if the fluid is free or located. \tn 
% Row Count 11 (+ 11)
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CT Scan & More reliable than CXR. \tn 
% Row Count 12 (+ 1)
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Treatment & • For {\bf{transudative}}, diuretics, sodium restriction, and {\bf{therapeutic thoracentesis}} if massive and causing dyspnea. \{\{nl\}\}• For {\bf{exudative}}, treat underlying disease. \{\{nl\}\}• For {\bf{parapneumonic effusions}}, antibiotics alone if uncomplicated. \{\{nl\}\}• {\bf{Complicated effusions or empyema require chest tube drainage}}, intracellular injection of thrombolytic agents (streptokinase or urokinase) to accelerate drainage, and/or surgical lysis of adhesions. \tn 
% Row Count 30 (+ 18)
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\begin{tabularx}{5.377cm}{x{1.59264 cm} x{3.38436 cm} }
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\seqsplit{Thoracentesis} & • Useful if etiology is not obvious. \{\{nl\}\}• Provides a diagnosis in 75\% of patients. \{\{nl\}\}• Drainage provides relief of symptoms for large effusions. \{\{nl\}\}• Pneumothorax is a complication in 10-15\% of cases, but requires treatment with a chest tube in \textless{}5\%. \{\{nl\}\}• Do not perform if effusion is \textless{}10mm thick on lateral decubitus CXR. \{\{nl\}\}• Send fluid for CBC, protein, LDH, pH, glucose, gram stain, and cytology, Chemistry, cytology, cell count, and culture. \tn 
% Row Count 18 (+ 18)
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Pleural Fluid Tests & • CBC, glucose, pH, amylase, TGs, microbiology, and cytology. \{\{nl\}\}• {\bf{Elevated pleural amylase}} is associated with esophageal rupture, pancreatitis, and malignancy. \{\{nl\}\}• Milky, opalescent fluid is a chylothorax. \{\{nl\}\}• Frankly purulent fluid is empyema. \{\{nl\}\}• Bloody effusion is associated with malignancy. \{\{nl\}\}• Exudative effusions that are primarily lymphocytic are associated with TB. \{\{nl\}\}• pH\textless{}7.2 is associated with parapneumonic effusion or empyema. \{\{nl\}\}• If glucose\textless{}60, rule out RA. Can also be low in other causes. \tn 
% Row Count 39 (+ 21)
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\begin{tabularx}{5.377cm}{x{1.69218 cm} x{3.28482 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pneumothorax}}  \tn
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Traumatic & • Often iatrogenic. \{\{nl\}\}• Always obtain a {\bf{CXR after transthoracic needle aspiration, thoracentesis, and central line}} placement. \tn 
% Row Count 6 (+ 6)
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Spontaneous Primary & • Occur without underlying lung disease. \{\{nl\}\}• Caused by {\bf{spontaneous rupture of subpleural blebs}} (air-filled sacs on the lung) at the apex of lungs. \{\{nl\}\}• Escape of air from the lung into the pleural space causes lung to collapse. \{\{nl\}\}• More common in tall, lean young men. \{\{nl\}\}• Patients have sufficient pulmonary reserve, so severe respiratory distress does not occur in most cases. \{\{nl\}\}• Recurrence rate is 50\% in 2 years. \tn 
% Row Count 24 (+ 18)
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Spontaneous Secondary & • Occurs as a complication of underlying lung disease, most commonly {\bf{COPD}}. \{\{nl\}\}• Smoking leads to chronic airway inflammation and formation of respiratory bronchiolitis. \{\{nl\}\}• The chronic destruction of alveoli leads to large alveolar blebs in the upper lobes, which can rupture and leak air into the pleural space. \{\{nl\}\}• Other conditions include asthma, ILD, neoplasms, CF, and TB. {\bf{More life-threatening because of lack of pulmonary reserve}}. \tn 
% Row Count 42 (+ 18)
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\begin{tabularx}{5.377cm}{x{1.69218 cm} x{3.28482 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pneumothorax (cont)}}  \tn
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Symptoms & {\bf{Ipsilateral chest pain}}, usually sudden in onset. Dyspnea, cough. \tn 
% Row Count 3 (+ 3)
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Signs & Decreased breath sounds, hyperresonance, decreased/absent tactile fremitus, {\bf{mediastinal shift toward the side}} of the pneumothorax. \tn 
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CXR & Shows visceral pleural line. \tn 
% Row Count 11 (+ 2)
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Treatment & • If small and asymptomatic, observation as it should resolve spontaneously in \textasciitilde{}20days. \{\{nl\}\}• Small chest tube with one-way valve may benefit some patients. \{\{nl\}\}• If pneumothorax is larger or symptomatic, supplemental oxygen and chest tube insertion. \{\{nl\}\}• If secondary, chest tube drainage is always indicated. \tn 
% Row Count 24 (+ 13)
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\begin{tabularx}{5.377cm}{x{1.34379 cm} x{3.63321 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Tension Pneumothorax}}  \tn
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\seqsplit{Pathophysiology} & • Accumulation of {\bf{air within the pleural space}} such that tissues surrounding the opening into the pleural cavity act as valves, allowing air to enter but not to escape.  \{\{nl\}\}• The accumulation of {\bf{air under positive pressure in the pleural space collapses the ipsilateral lung }}and shifts the mediastinum away form the side of the pneumothorax. \tn 
% Row Count 13 (+ 13)
% Row 1
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Causes & Trauma, CPR, mechanical ventilation with associated barotrauma. \tn 
% Row Count 16 (+ 3)
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Signs & Hypotension ({\bf{cardiac filling is impaired due to compression of the great veins}}), distended neck veins, {\bf{shift of trachea away from pneumothorax}}, decreased breath sounds, hyper resonance to percussion. \tn 
% Row Count 24 (+ 8)
% Row 3
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Treatment & Do not order CXR. Medical emergency. The patient is likely to die of hemodynamic compromise. {\bf{Immediately decompress with large-bore needle}} or chest tube. \tn 
% Row Count 30 (+ 6)
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\mymulticolumn{2}{x{5.377cm}}{.}  \tn 
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% That's all folks
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