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* CMS- how do you know .....???
 #843449  
  ckpath - 08/12/17 20:55
 
  How do you know this is empyema?

A 47-year-old woman is brought to the emergency department because of a 1-day history of temperatures to 39.4C (103F) and shortness of breath and a 6-hour history of chest pain exacerbated by cough or inspiration. Three days ago, she started treatment with erythromycin for fever and cough productive of yellow sputum, but she discontinued the medication 24 hours later because of nausea and vomiting. She has autoimmune hepatitis that has been in remission for 3 years. She appears lethargic. Her temperature is 39C (102.2F), pulse is 120/min, respirations are 32/min, and blood pressure is 110/70 mm Hg. There is dullness to percussion over the left hemithorax two thirds of the way up from the lung bases. Breath sounds are decreased at the left base. Cardiac examination shows a hyperdynamic precordium with no rubs, gallops, or murmurs. Thoracentesis is performed. Laboratory studies show:
Hematocrit 40%
Leukocyte count 20,000/mm3
Segmented neutrophils 80%
Bands 15%
Lymphocytes 5%
Pleural fluid
Leukocyte count 50,000/mm3
pH 7.11
Glucose 20 mg/dL
Total protein 4 g/dL
Lactate dehydrogenase 400 U/L

Which of the following is the most appropriate next step in management?

A
)
Admission to the coronary care unit

B
)
Chest tube placement
C
)
Instillation of talc in the pleural space

D
)
Intravenous corticosteroid therapy

E
)
Intravenous heparin therapy

F
)
Oral naproxen therapy

G
)
Pericardiocentesis

H
)
Surgical repair
 
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* Re:CMS- how do you know .....???
#3345940
  endo17 - 08/17/17 11:47
 
  Answer: B
1) look for LDH >200
2) Prt 4 g/dl
3) Prt effusion/serum retio >.5
 
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