https://docs.google.com/presentation/d/1KNQ8BNX5dflDU3wzMNg0VpKxgQzFiMLZEr90XUikOtQ/edit?usp=sharing
1- Most reliable finding elevated serum ALP (70%)
2- LFTs only 50% elevation bilirubin, 48% elevation AST
3- Leukocytosis 77%, normocytic anemia in 50%
4- hypoalbuminemia in 33%
5- Concomitant bacteremia in 1/3rd - ½ of pts
6- CXR w/ new R hemidiaphragm, R basilar infiltrate, R pleural effusion
If > 5cm percutaneous drainage
When to stop?
If fever stops in 24-48h can take drain out
If continues to fever, repeat CT scan, serial CXRs to insure adequate drain placement
Drain < 10ml of output for liver abscess
•Three chamber chest tube initiated on [Date] for [indication] by [service] w/ pleurevac drainage set to -20 and wall suction set to -80, there is tidaling w/ respiration, daily drainage was [<100cc/day] w/ no air leak. Drainage unit placed in gravity dependent area on ground Lung sounds clear, no crepitus on palpation. Chest tube clean, not kinked.
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•Chest tube removal: Today, daily drainage was [no air leak for ptx, <50mL for empyema, < 100mL for pleural effusion] Chest tube removed on expiration after coughing and pt humming. Covered w/ xeroform, 4x4 gauze, tegaderm for 48 hours.
Where to go after chest tube is placed
Thoracostomy tubes drains 10 - 14 French (can upsize)
Intrapleural fibrinolytic (streptokinase, urokinase, tpa)
/ mucolytic agent (DNASE) shown to decrease size
May require surgical debridement
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