A 56-year-old man comes to the emergency department because of a 4-day history of fever and shortness of breath. He has a history of COPD treated with inhaled albuterol. His temperature is 39.0°C (102.2°F), pulse is 95/min, respirations are 20/min, and blood pressure is 130/80 mm Hg. Cardiopulmonary examination shows decreased breath sounds and poor air movement over the left lung. Chest radiograph shows a moderate-sized loculated pleural effusion on the left side. Ultrasonography reveals multiple separate fluid pockets within the pleural space. Chest tube placement produces only a small amount of thick pus. Intrapleural administration of a medication with which of the following effects would most likely improve chest tube drainage in this patient?

Question

A 56-year-old man comes to the emergency department because of a 4-day history of fever and shortness of breath. He has a history of COPD treated with inhaled albuterol. His temperature is 39.0°C (102.2°F), pulse is 95/min, respirations are 20/min, and blood pressure is 130/80 mm Hg. Cardiopulmonary examination shows decreased breath sounds and poor air movement over the left lung. Chest radiograph shows a moderate-sized loculated pleural effusion on the left side.  Ultrasonography reveals multiple separate fluid pockets within the pleural space.  Chest tube placement produces only a small amount of thick pus.  Intrapleural administration of a medication with which of the following effects would most likely improve chest tube drainage in this patient?

Quizplus · Accepted Answer

Eductional Objective: This patient's pleural effusion is due to increased pulmonary capillary permeability, most likely caused by inflammation from pneumonia (parapneumonic effusion). Administration of a fibrinolytic agent (eg, tissue plasminogen activator) in combination with a nucleic acid cleaving enzyme (ie, deoxyribonuclease) can ffacilitate chset tube drainage.

A 56-Year-Old Man Comes to the Emergency Department Because of a 4-Day