191) A 68-year-old man with history of chronic obstructive pulmonary disease presents with increasing shortness of breath and increasing sputum production over the past 5 days. The patient also has history of atrial fibrillation for which he is on beta blocker and aspirin. Physical examination reveals a fever of 102°F, scattered wheezes and reduced breath sounds at the right lung base. He is awake and oriented to place, person and time. EKG shows atrial fibrillation that is rate controlled. Chest X-ray reveals a new right sided pleural effusion. A diagnostic thoracentesis is planned. Which of the following is a contraindication for thoracentesis in this patient?
a. Fever > 101F
b. A new right sided effusion
c. Severe left lung disease
d. Atrial Fibrillation
e. Age
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d . AF
D
C….
http://reference.medscape.com/features/slideshow/thoracentesis
c) severe left lung disease
Potential contraindication to thoracocentesis are
-coagulopathy INR >2 or platelet count <25,000
-severe lung disease on the contralateral lung
-mechanical ventilation
-chest wall cellulitis
AF
Plz send me a ans!
Ans=c Contraindications
Uncooperative patient
Uncorrected bleeding diathesis (INR >2.5, Plts <40)
Chest wall cellulitis at the site of puncture
Severely decreased lung function, high PEEP, or single lung-patient unable to tolerate a
possible complication (e.g. pneumothorax or hemothorax)
C:)