hospitalized immediately. Interim therapy is treatment aimed at preventing further attacks. The offending allergens should be identified and emotional disturbances eliminated, if possible. Drugs of choice in the interim therapy of asthma are the adrenal corticosteroids and corticotropin. Methylprednisone and IV hydrocortisone are the drugs normally used. A change in environmental conditions is indicated to prevent incapacitating or further complications.
This condition is the result of deposits of fibrinous exudate on the pleural surface. It is usually secondary to pulmonary disease.
SYMPTOMSThere is chest pain that is accentuated upon inspiration and minimal when the breath is held. The patient often lies on the affected side and respirations are decreased in motion and may be marked with a grunt. A pleural friction rub is often present.
TREATMENTThe treatment of the pleuritic pain is the only measure aimed at combating the fibrinous pleurisy. Other treatment is aimed at the underlying cause. Giving analgesics and strapping the chest to restrict movement is effective in treating the pain.
This is a localized area of necrosis in the lung that may be putrid or nonputrid. Bronchial obstruction with subsequent infection distal to the block may be caused by aspirated vomitus, blood, pus, or mucus. It may also follow penetrating wounds of the chest. Putrid abscesses are usually single and caused by anaerobic bacteria. The right lung, especially the lower lobes, is most frequently affected. Nonputrid abscesses are usually hematogenous in origin and are usually multiple.
SYMPTOMSThey include malaise, anorexia, cough, sweating, chills, and fever. The cough is at first nonproductive and later yields a foul, fetid sputum that is suggestive of an abscess.
TREATMENTGeneral measures consist of bed rest, postural drainage in the position of best drainage, and broad-spectrum antibiotic therapy. The patient may require evacuation for surgical resection, which is the treatment of choice when the risk is reasonable.
This condition results from air entering the pleural space, causing a partial to complete collapse of the underlying lung. It sometimes follows exertion or violent coughing. Occasionally a valvelike effect is produced with progressive air leakage upon inspiration and failure of air exit upon expiration (tension pneumothorax).
SYMPTOMSChest pain is referred to the shoulder and arm of the affected side. The pain is aggravated by inspiration and physical activity. Breath and voice sounds are diminished on the affected side; in large pneumothorax, there is a mediastinal shift to the opposite side. Percussion produces hyperresonance.
TREATMENTIf the degree of lung collapse is small, air leakage slight, and little discomfort produced, the lung may reexpand spontaneously. If the degree of collapse is greater, the leakage of air more pronounced, and the patients discomfort great, insert a large-bore, short bevel needle into the anterior portion of the affected area. Insert it just into the pleural space to avoid trauma to the underlying lung. After tension is relieved, make a one-way valve from the finger of a rubber glove, slit at the end, and tied to the hub of the needle. As soon as possible, insert a Foley catheter into the pleural space and attach to a water trap (underwater seal) or a suction pump. Provide suction until the lung has been reexpanded for 24 hours. Treat severe pain with subcutaneous morphine. Treat for shock.
A sucking chest wound results from a penetrating injury to the chest wall and is a surgical emergency. The wound must be made airtight by any available means, as this might convert the injury to a tension pneumothorax. If the patient becomes increasingly dyspneic, remove the dressing to allow release of internal pressure, then reseal. Treat for shock. Surgical intervention should be accomplished as soon as possible.
This condition results from a clot lodging in a pulmonary vessel. The major causes are chronic cardiac disease, phlebitic or thrombosed veins of the lower extremities, postoperative complication (second or third week usually), and traumatic fractures (fat embolism).