empyema-171013100219.................pptx

Tttt.......

1. EMPYEMA

2. Empyema An accumulation of thick, purulent fluid within the pleural space, often with fibrin development

3. Causes/Risk Factors Presence of bacterial pneumonia or lung abscess Penetrating chest trauma Hematogenous infection of the pleural space Iatrogenic causes (after thoracic surgery or thoracentesis )

4. ORGANISMS Staphylococcus aureus , Streptococcus pneumoniae and Streptococcus pyogenes

5. Presence of Parapneumonic Effusion  Release of inflammatory mediators  Pathophysiology

6.  ↑permeability of the capilliaries   Attracts WBCs to the site Escape of albumin & other protein from the capillaries 

7.  ↑ Pleural fluid  Presence of free-flowing, protein rich pleural fluid (Stage I) 

8.  Inflammation worsens  Attracts more WBCs to the site 

9.  Extensive purulent exudate production  Initiation of fibroblastic activity (Stage II) 

10.  Adherence of the two pleural membranes (Stage III)  Formation of a “ peel l ”

11. Stages of Empyema Exudative stage (1-3 days ) Fibrino purulent stage (4 to 14 days) Organizing stage (after 14 days)

12. Exudative stage (1-3 days) Immediate response with outpouring of the fluid. Low cellular content It is simple parapneumonic effusion with normal pH and glucose levels.

13. Fibrino purulent stage (4 to 14 days) Large number of poly- morphonuclear leukocytes and fibrin accumulates Acumulation of neutro-phils and fibrin, effusion becomes purulent and viscous leading to development of empyema.

14. Organizing stage (after 14 days) Fibro-blasts grow into exudates on both the visceral and parietal pleural surfaces Development of an inelastic membrane "the peel". Most common in S. aureus infection. Thickened pleural peel can restrict lung movement and it is commonly termed as trapped lung

15. DIAGNOSIS LAB INVESTIGATIONS CBC count Blood culture Serum LDH Total protein Bacterial , mycobacterial, and fungal cultures

16. X-RAY Large pleural effusion can be diagnosed in posteroanterior view Lateral decubitus view with affected side inferior facilitates recognition of smaller volumes of fluid .

17. Sonography or CT imaging Chest CT imaging to detect : - pleural fluid and image the airways - guide interventional procedures

18. 19 CLINICAL MANIFESTATIONS Like bacterial pneumonia Acute febrile response, pleuritic chest pain, cough, dyspnea, and possibly cyanosis Abdominal pain, vomiting Splinting of the affected side

19. 20 TREATMENT Control of the infection Drainage of the pleural fluid Appropriate antibiotic : 10-14 days / IV Oxygen Oral antibiotics for 1-3 weeks after discharge if complicated infections (+)

20. 21 ANTIBIOTICS Cefuroxime = 150 mg/kg/day (: 3 dose) Clyndamycin = 25 – 40 mg/kg/day (: 3 dose) Good  most patients recover without sequelae Early recognition  initiation of definitive therapy reduce morbidity and complications

21. THORACENTESIS

22. Nursing Diagnosis Impaired Gas Exchange r/t compressed lung Acute Pain r/t infection of the pleura Risk for Activity Intolerance r/t hypoxia secondary to empyema