BUMC Basics.pdf - Anesthesia Home
BUMC Basics.pdf - Anesthesia Home
BUMC Basics.pdf - Anesthesia Home
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94<br />
PLEURAL EFFUSION<br />
Thoracentesis needed if effusion >1 cm in decubitus view; also<br />
patient with fever, chest pain, unilateral effusion, or new<br />
effusion. Parapneumonic effusions should be tapped ASAP.<br />
Transudate versus Exudate:<br />
1. Light’s criteria:TP eff/TP serum=>0.5, LDH eff/LDH<br />
serum >0.6, or LDH eff > 2/3 upper limit of normal of<br />
LDH serum (Best sensitivity but will misidentify 25%<br />
of transudates as exudates). Light’s criteria is most<br />
used and clinically applicable.<br />
2. Exudative criteria with better specificity: two test rule<br />
(pleural fluid cholesterol >45 and pleural fluid LDH<br />
>0.45 times upper limit of normal serum LDH), or<br />
three test rule (pleural fluid protein >2.9, pleural fluid<br />
cholesterol >45, and pleural fluid LDH >0.45 times<br />
upper limit of normal serum LDH)<br />
Complicated versus Uncomplicated Parapneumonic<br />
effusion:<br />
1. Complicated=positive gram stain or culture or pH
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