Question of the Week # 191

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

8 Responses

  1. d . AF

  2. 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

  3. 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)

  4. C:)

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