RESPIRATORY

PLEURAL EFFUSION

Introduction

5 min

Introduce yourself and the group

Provide rationale for the session and relevance to clinical practice

Outline learning objectives:

Be able to take a focussed history from a patient presenting with possible pleural effusion and consider appropriate differential diagnoses
Suggest and interpret results of relevant investigations for suspected pleural effusion
Understand the initial management of a patient with pleural effusion
Be aware of the indications and risks of pleural procedures for pleural effusions

Explain structure of session

Total time:

45 min

Number of students:

1-5

Grade of students:

3rd to 5th year medical students

Created by:

Dr Charlotte Hayden

Uploaded:

14th September 2019

Last updated:

14th September 2019

Resources needed for this session:

Pen, paper, whiteboard or flipchart paper if possible

Students can scan the QR code opposite to view all investigation results on their phone as you work through the session.

Resources linked to this session:

None

Activity 1: Examination Skills

10 min

Ask student(s) to perform a focused respiratory examination on a patient with suspected pleural effusion. This can be observed if capacity of tutors allows.

Activity 2: Diagnostic Reasoning

5 min

Ask the student to summarise the key positive and negative findings of the case. Feedback on examination technique and presentation (max 1 minute).

Discussion points:

What differential diagnoses have you considered and why are these less likely?
What initial investigations would be useful and what are you expecting them to show?

Activity 3: Pathophysiology

5 min

Recap basic pathophysiology with the student(s). Using a whiteboard or flip chart paper if possible, construct a mind-map covering the following points:

What kinds of fluid can accumulate in the pleural space? What is the mechanism behind these?
How can pleural effusions be classified?
What are the differential diagnoses for dullness to percussion and/or reduced vocal resonance?

Activity 4: Basic Radiology Interpretation

5 min

Allow the student(s) to view the patient’s chest x-ray. If none is available, use the examples below. Ask the student(s) to systematically interpret the x-rays in turn.

Example 1:

What is the most obvious abnormality?
How would you expect the patient to appear clinically?

Example 2:

How does this differ to the example above?
How would you expect the patient to appear clinically?

Activity 5: Further Management

10 min

Ask the student(s) to find some relevant guidelines on the management of pleural effusions (e.g. BTS Pleural Guidelines 2010 accessed via the QR code opposite). Allow them to consider or discuss amongst themselves how best the patient they have seen should be managed. Some prompts for discussion:

Does this patient need a pleural procedure? If so, what kind?

Activity 6: Procedures

10 min

If the patient goes on to have a pleural procedure e.g. pleural aspiration or chest drain insertion, ask the student(s) to complete the following tasks:

Find the local LocSSIPs for pleural procedures. Work through the questions with reference to the patient they have seen. The QR code opposite links to an example LocSSIP.
Find and complete the relevant sections of a mock consent form with the indication and risks for the procedure. Practice taking consent from a each other if possible. NB. Medical students should not take consent from the patient - this should be done by the qualified professional performing the procedure.