pleural procedures and thoracic ultrasound BTS 2010 guidelines

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BTS 2010 chest drain and pleural aspiration guidelines

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Tom Havelock, Richard Teoh, Diane Laws, et al. British Thoracic Society pleural disease guideline 2010

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What is fixation? Fixation in orthopedics is the process by which an injury is rendered immobile. This may be accomplished by internal fixation, or by external fixation. What is internal fixation? Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone Rigid internal fixation refers to the direct method of fracture fixation where the hardware or implant used for fixation provides sufficient rigidity for the jawbone to withstand masticatory stresses. Avoids immobilization by MMF Does not allow micromotion of fracture segments Goals of AO/ASIF technique for rigid fixation Anatomic reduction of bone fragments Functionally stable fixation of the fragments Preserving the blood supply to the fragments by atraumatic surgical procedures Early, active and pain free mobilisation Compression osteosynthesis Based on AO/ASIF principles These plates included pear-shaped holes at the extreme ends Dynamic compression plate Produce compression between bone fragments on activation 300kPa/cm2 Indication Nonoblique fracture with good bony apposition after reduction Contraindications Severely oblique fracture Comminuted fracture Fracture with bone loss Properties of plate Plate has inclined plane in the hole proximal to the fracture The highest portion of the inclined plane lies on the outer aspect 2 types of screws- compression screw and static screw Min two screws on each side Unfavourable fracture requires longer plates with more screws Order of fixation Plate bending Bicortical screws are used Fixation protocol Disadvantages Require precise adaptation If used on oblique fractures, the fragments slide over one another Maladapted plate in anterior mandiblecreates widening of mandible Technique sensitive Ideally should be placed on tension zone, but due to anatomic reasons the plate is placed on the inferior border In fracture with good reduction and no bone loss, causes stripping of screws and bone splintering adjacent to fracture Eccentric dynamic compression plate Used in situations where tension band application is not possible Presence of impacted 8 with angle fracture Edentulous mandibular fracture Avulsion of bone from fracture site Plate design Advantage Even distribution of forces along length of fracture Disadvantage Technique sensitive Results not superior to other fixation methods Lag screw Oblique fracture in long bones Principle- a screw that glides through the cortex of one fragment and engages the cortex of the opposite fragment with its thread, draws the fragments together and compresses them when tightened. Gliding holes and thread holes must be coaxial - (Pics) Fixation osteosynthesis This includes Reconstruction plate THORP Locking plate Indications Oblique fracture Comminuted fracture Loss of bone fragments in fracture Questionable post op compliance Non atrophic edentulous fracture Reconstr

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Thoracentesis (thor-a-sen-tee-sis) is a procedure that is done to remove a sample of fluid from around the lung. The lung is covered with a tissue called the pleura. The inside of the chest is also lined with pleura. The space between these two areas is called the pleural space. This space normally contains just a thin layer of fluid, however, some conditions such as pneumonia, some types of cancer, or congestive heart failure may cause excessive fluid to develop (pleural effusion). Thoracentesis, also known as pleural fluid analysis, is a procedure in which a needle is inserted through the back of the chest wall into the pleural space (a space that exists between the two lungs and the anterior chest wall) to remove fluid or air. Pleural fluid analysis is the microscopic and chemical lab analysis of the fluid obtained during thoracentesis. IndDiagnostic: determination of pleural effusion etiology (e.g. transudative versus exudative) usually requires the removal of 50 to 100mL of pleural fluid for laboratory studies. Most new effusions require diagnostic thoracentesis, an exception being a new effusion with a clear clinical diagnosis (e.g. CHF) with no evidence for superimposed pleural space infection Therapeutic: reduce dyspnea and respiratory compromise in patients with large pleural effusions. This is typically achieved by removing a much larger volume of fluid compared to the diagnostic thoracentesis ications

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