BASIC PULMONARY LIFE SUPPORT

BPLS - 2015

dr. Setia Putra Tarigan, Sp.P (K)

Department of Pulmonology and Respiratory Medicine
Faculty of Medicine University of Sumatera Utara
Adam Malik General Hospital
Medan
 Pleural effusions is an accumulation of pleural
fluid in the pleural space

 Massive pleural effusion:

 Pleural effusion with opacification on entire
hemithorax
 Mediastinum is shifted toward the contralateral side
 Dyspnea
 Reduction in lung volumes
 Ventricular filling may be
impeded leading to decreased
cardiac out put
SYMPTOMS PHYSICAL EXAM

 Dyspnea  I: Discrepancy in size of

 Pleuritic chest pain hemithorax
 Non-productive cough  P: Decreased tactile
fremitus
 P: Dullness to
percussion
 A: Decreased breath
sounds
Minimal free pleural effusion Moderate free pleural
effusion

Large free pleural effusion Massive pleural effusion

 Thoracocentesis terapeutic

 Chest tube insertion

 = THORACENTESIS
 = PLEURAL ASPIRATION
 = PLEURAL TAPPING
 Ensure documented
consent is obtained
(encompass common and
serious complications)
 Complications:
pneumothorax, procedure
fail, pain, haemorrhage,
visceral injury.
 Patient position and site of
insertion: the preferred
site for insertion of the
needle should be the
triangle safety
 Equipment:
 Skin sterilising fluid: alkohol 70% and povidone
iodine
 A clean dressing
 A 10 ml syringe
 A 50 ml syringe
 A three-way tap
 Intravenous cannula/abbocath 14
 Tubing/syringe
 Lidocaine 2%
 Sterile gloves
 Procedure:
1. Local anaesthetic is infiltrated into the site of
thoracocentesis
2. A 10 ml syringe is used to raise a dermal bleb before
deeper infiltration of the intercostal muscles and
pleural surface (a spinal needle may be required in the
presence of a thick chest wall)
3. Local anaesthetic such as lidocaine (up to 3 mg/kg)
is usually infiltrated. Higher doses may result in
toxic levels
4. The pleural space should be aspirated with the
needle used to administer the local anaesthetic
 Procedure (continued…)
5. The aspiration needle or cannula/abbocath 14
should then be advanced into the chest, aspirating
continually until the pleura is breached and fluid are
withdrawn
6. The cannula/abbocath 14 should then be attached to
a three-way tap and fluid withdrawn into the syringe
and expelled via the free port of the three-way tap into
a bag or jug for fluid
7. This process should be repeated and continued until
the procedure is terminated.
8. The cannula/abbocath 14 is then removed and
simple dressing applied
 The procedure should be stopped
 When no more fluid can be aspirated
 The patient develops symptoms of cough or chest
discomfort, or
 1.5 l has been withdrawn
 Because massive pleural effusion is a sign of
disease and not a diagnosis in itself, after
therapeutic thoracocentesis  the patient
should be referred to the pulmonologist for
further management.
 http://www.nejm.org/doi/full/10.1056/NEJMvc
m053812
JUAH