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    Empyema 171013100219

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    Mahmoud Abdel Moneim
    Empyema is an accumulation of thick, purulent fluid in the pleural space caused by bacterial pneumonia, lung abscesses, or chest trauma. It develops in stages from an exudative parapneumonic effusion to a purulent, fibrous peel between the pleural membranes. Symptoms include fever, chest pain, and difficulty breathing. Diagnosis involves imaging and fluid analysis. Treatment requires drainage of pleural fluid and intravenous antibiotics for 10-14 days followed by oral antibiotics to resolve the infection fully.

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    Empyema 171013100219

    Uploaded by

    Mahmoud Abdel Moneim
    139 views23 pages
    Empyema is an accumulation of thick, purulent fluid in the pleural space caused by bacterial pneumonia, lung abscesses, or chest trauma. It develops in stages from an exudative parapneumonic effusion to a purulent, fibrous peel between the pleural membranes. Symptoms include fever, chest pain, and difficulty breathing. Diagnosis involves imaging and fluid analysis. Treatment requires drainage of pleural fluid and intravenous antibiotics for 10-14 days followed by oral antibiotics to resolve the infection fully.

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    Empyema is an accumulation of thick, purulent fluid in the pleural space caused by bacterial pneumonia, lung abscesses, or chest trauma. It develops in stages from an exudative parapneumonic effusion to a purulent, fibrous peel between the pleural membranes. Symptoms include fever, chest pain, and difficulty breathing. Diagnosis involves imaging and fluid analysis. Treatment requires drainage of pleural fluid and intravenous antibiotics for 10-14 days followed by oral antibiotics to resolve the infection fully.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    139 views23 pages

    Empyema 171013100219

    Uploaded by

    Mahmoud Abdel Moneim
    Empyema is an accumulation of thick, purulent fluid in the pleural space caused by bacterial pneumonia, lung abscesses, or chest trauma. It develops in stages from an exudative parapneumonic effusion to a purulent, fibrous peel between the pleural membranes. Symptoms include fever, chest pain, and difficulty breathing. Diagnosis involves imaging and fluid analysis. Treatment requires drainage of pleural fluid and intravenous antibiotics for 10-14 days followed by oral antibiotics to resolve the infection fully.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 23

    EMPYEMA

    Empyema
    An accumulation of
    thick, purulent fluid within
    the pleural space, often
    with fibrin development
    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)
    ORGANISMS
    Staphylococcus aureus, Streptococcus
    pneumoniae and Streptococcus pyogenes
    Pathophysiology
    Presence of Parapneumonic
    Effusion

    Release of inflammatory
    mediators


    permeability of the capilliaries

    Attracts WBCs to the site


    Escape of albumin & other
    protein from the capillaries


    Pleural fluid

    Presence of free-flowing, protein


    rich pleural fluid
    (Stage I)


    Inflammation worsens

    Attracts more WBCs to the


    site


    Extensive purulent exudate production

    Initiation of fibroblastic activity


    (Stage II)


    Adherence of the two pleural
    membranes
    (Stage III)

    Formation of a peell
    Stages of Empyema
    Exudative stage (1-3 days )

    Fibrino purulent stage (4 to 14 days)

    Organizing stage (after 14 days)


    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.
    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.
    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
    DIAGNOSIS
    LAB INVESTIGATIONS
    CBC count
    Blood culture
    Serum LDH
    Total protein
    Bacterial, mycobacterial, and fungal cultures
    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.
    oSonography or CT imaging

    o Chest CT imaging to detect :


    - pleural fluid and image the
    airways
    - guide interventional procedures
    CLINICAL MANIFESTATIONS

    o Like bacterial pneumonia


    o Acute febrile response, pleuritic
    chest pain, cough, dyspnea, and
    possibly cyanosis
    o Abdominal pain, vomiting
    o Splinting of the affected side

    19
    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
    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
    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

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