hospitalized immediately. Interim therapy is treat-
ment 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 pleu-
ritic 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 effec-
tive 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
SYMPTOMSThey include malaise, ano-
rexia, cough, sweating, chills, and fever. The
cough is at first nonproductive and later yields
a foul, fetid sputum that is suggestive of an
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).