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What is a thoracentesis?
Diagnostic or therapeutic procedure which a needle is inserted into the chest to remove air/fluid from the pleural space.
What disorder do you use a thoracentesis?
What is position do you put a patient in during a thoracentesis?
Patient sitting up and leaning forward.
Where do you insert the needle?
7th or 8th intercostal space at the site of maximal dullness.
How much is aspirated after a thoracentesis?
100 to 300 ml of pleural fluid with 50 mL syringe.
What color is transudate fluid and what disease is it associated with?
- Clear and has light straw color
- Congestive heart failure
Opaque appearance and called exudate fluid
Pleural fluid with an infection is what color
yellow or milky exduate fluid
Central sleep apnea
apnea due to loss of ventilation effort
Obstructie sleep apnea
blockage of upper airway
What is the history and presenation of sleep apnea disorders
- Daytime sleepiness and insomnia at night.
- Muscle twitching
- History of snoring and obesity
How do you confirm a patient has sleep apnea?
observation in sleep lab (polysmnography)
What does the sleep study include?
- Chest motion detectors to measure respiratory effort
- Flow detectors to measure nasal flow
- Oximetry measure oxygen desaturation
If nasal flow decrease & respiratory effort decreases then desaturation results in
Treatment for sleep apnea
- Weight loss
- Respiratory stimulants
- Nasal/mask CPAP and or NIPPV therapy
What is the maximum CPAP Level
What should be used first CPAP or Bi-Level
- Patient cant tolerate high pressures on CPAP
- Continued obstructive respiratory events when patient reaches CPAP presure 15 cmH2O
Indications for NPPV (BPAP,BiPAP)
- Increases patients tolerance of PAP thearpy
- To treat central sleep apnea
When is a chest tube required?
- Air enters pleural space with little or no fluid.
- If air cant escape lung mediastinum is affected pushing it away from affected side=tension pnumothorax.
Hemothorax or pleural effusion
- Fluid enters pleural cavity with no air.
- Insert large bore needle to relieve pressure. Insert chest tube
Chest tube placement draining air
Placed in anterior chest (second intercostal space in midclavicular line)
Chest tube placement drain Fluid
Placed in 4th or 5th intercostal space in midaxillary line.
Removing chest tube
- Tube clamped 24hrs before removing tube.
- Observed for respiratory distress
- X-ray taken
- Just before removing tubes patient takes deep breath, exhales & performs valsalva maneuver.