Upper Vs. Lower in ICD-10
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Management of Parapneumonic Effusion and Empyema Sarvinder Singh, Santosh Kumar Singh, Ajai Kumar Tentu
[Downloaded free from http://www.jacpjournal.org on Friday, November 29, 2019, IP: 176.240.166.40] Review Article Management of parapneumonic effusion and empyema Sarvinder Singh, Santosh Kumar Singh, Ajai Kumar Tentu Military Hospital, Namkum, Parapneumonic effusions are pleural effusions that occur in the pleural space adjacent Ranchi, Jharkhand, India to a bacterial pneumonia. When bacteria invade the pleural space, a complicated parapneumonic effusion or empyema may result. Empyema is collection of pus in BSTRACT pleural cavity. If left untreated, complicated parapneumonic effusion/empyema leads A to chronic encasement and pleural thickening. Simple parapneumonic effusions can be managed conservatively with appropriate antibiotics, but complicated parapneumonic effusions often require some kind of drainage along with antibiotics. Delay in treatment is associated with high morbidity and mortality. Clinically it is diagnosed with persistent fever, stony dull tender percussion, and absent breath sounds. Majority of cases are due to anaerobic infection. Gram-positive as well as Gram-negative organisms are also implicated. Many cases may have mixed organisms. Tuberculosis should be suspected if no organism is grown in empyema. Chest skiagram, thoracic ultrasound, and CT scan help in localization of effusion and detection of loculations. Confirmation is done by thoracocentesis and pleural fluid analysis, which shows exudate with polymorphonuclear leukocytosis. Management includes well-selected antibiotics and drainage by tube thoracostomy. Intrapleural fibrinolytics have been used in multiloculated complicated parapneumonic effusions with success. Advent of thoracoscopy and VATS has left very few cases requiring surgical decortication. Properly treated parapneumonic effusions have good prognosis. KEYWORDS: Pleural effusion, empyema, chest tube thoracostomy, intrapleural Received: 1 December 2018 Accepted: 27 March 2019 fibrinolysis, VATS INTRODUCTION intrapleural debridement in parapneumonic empyema in [4] arapneumonic effusions are pleural effusions that 1950. -
Coding for Respiratory Services
Coding for Respiratory Services Audio Seminar/Webinar June 18, 2009 Practical Tools for Seminar Learning © Copyright 2009 American Health Information Management Association. All rights reserved. Disclaimer The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. CPT® five digit codes, nomenclature, and other data are copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. -
Community Acquired Pneumonia (CAP), Complicated
CLINICAL PATHWAY COMPLICATED COMMUNITY ACQUIRED PNEUMONIA (CAP) ALGORITHM Inclusion Criteria: 90 days through 21 years of age with signs, symptoms, or other findings suggesting a diagnosis of complicated Off Pathway: pneumonia acquired by exposure to • If sepsis is suspected, reference organisms in the community. the sepsis CCG Start: Exclusion Criteria: • For patients under 90 days of age No Confirmed diagnosis of pneumonia and parapneumonic Immune-compromised host, chronic pleural consider these CCGs: Infant fever effusion? disease, systemic illness concerning less than 28 days and infant for sepsis or hospital fever 28-90 days acquired pneumonia Yes Small effusion size: Effusion Moderate effusion size: Large effusion size: Effusion opacity less than ¼ of thorax Effusion opacity greater than ¼ but less opacity greater than ½ of thorax than ½ of thorax Treat with Symptoms less Symptoms greater antibiotics. Do than 10 days than 10 days NOT obtain pleural fluid for culture and do not attempt pleural drainage Degree of Obtain pleural fluid Consider primary Moderate to for culture and Video Assisted respiratory Severe drain the pleural Thorascopic compromise? space of fluid Surgery (VATS) Is patient responding to Mild treatment? Yes No Options for drainage: 1. Chest tube alone: If no change within Treat with antibiotics and 12 hours, add fibrinolytics. consider thoracentesis 2. Chest tube with fibrinolytics: If not responding within 24 hours, then proceed *Chest US or CT may be to VATS. Continue Reassess performed in conjunction 3. Proceed directly to VATS antibiotics effusion size with IR drainage or if needed, surgical localization *Chest US or CT may be preformed in conjunction with IR drainage or if needed for surgical localization Is the effusion still small in If clinical condition is size? worsening despite Yes No appropriate IV antibiotics, then proceed to the algorithm for large effusion Continue Follow algorithm antibiotics, but do for moderate or NOT attempt large effusion pleural drainage Adapted from Bradley et al. -
Complicated Pediatric CAP Guideline SIU-SOM This Guideline Applies to Children 90 Days of Age and Older
Complicated Pediatric CAP guideline SIU-SOM This guideline applies to children 90 days of age and older. All neonates with pneumonia should be hospitalized and treated with empiric antimicrobial therapy similar to neonatal sepsis treatment. DEFINITIONS Community Acquired Pneumonia: Infection of airways and lung tissue caused by a multitude of organisms, including a viral and bacterial etiology, which was acquired outside of the hospital. Pleural effusion: Excess fluid between the visceral and parietal pleurae that cover the lungs. Complicated Pneumonia: Pneumonia with significant effusion empyema, necrotizing pneumonia, severe or impending respiratory failure, and/or signs and symptoms of sepsis or shock. Parapneumonic effusion: A type of pleural effusion that arises as a result of a pneumonia, lung abscess, or bronchiectasis. Parapneumonic effusions evolve through three stages: - Exudative: sterile, free-flowing fluid, 2-5 days after the onset of the effusion - Fibro-purulent: deposition of fibrin over the visceral and parietal pleurae, fluid becomes loculated or septated, 5-10 days after the onset of the effusion. - Organized: A thick and stiff pleural peel or rind develops and is attached to both visceral and parietal pleurae, 10-14 days after the onset of the effusion. Parapneumonic effusions are also classified by size: - Small effusion: < 10 mm rim of fluid on lateral decubitus or less than one-fourth of the hemi thorax opacified on an upright chest radiography - Moderate effusion: more than one fourth but less than half of the