Management of Empyema Thoracic

The principle of treatment in empyema:
1. Emptying of the pleural cavity of pus
2. Antibiotics
3. Closure of the pleural cavity
4. Causal treatment
5. Additional treatment.

1. Emptying of the pleural cavity.
a. Simple aspiration.

Performed repeatedly using a large needle hole. This method is good enough to remove most of the pus or fluid from acute empyema is still runny.
Losses such as these techniques often lead to "pocketed" empyema.
Ultrasound can be used to determine the localization of "pocketed" empyema.

b. Drainage is closed.

Installation "= closed thoracostomy tube drainage (WSD)".
Indications of this drain fitting, if the pus is very thick, pus is formed after 2 weeks and there has been piopneumotoraks.
Installation of the hose should not be too low, the diaphragm is usually raised because of empyema. Select a hose that is large enough.
If 3-4 weeks of no progress should be pursued by other means, such as in chronic empyema.

c. Installation of "open-drainage":

This action is done on a chronic empyema by cutting a piece of rib to create a "window". This method is chosen when dekortikasi not possible and should be done in a completely sterile condition.

2. Antibiotics.

Given the major cause of death due to sepsis, then antibiotics play an important role.
Antibiotics should be given immediately once the diagnosis is established and the diagnosis should adcquate. The selection of antibiotics based on results of Gram staining of pus smear.
Subsequent treatment depends on the culture results and sensitivity tests.
When germs that cause is unclear, can be used high doses of benzyl penicillin.

3. Closure of the pleural cavity.

When chronic empyema fails to show a response to the drainage hose, then do dekortikasi or torakoplasti.
If not handled properly will add to the long hospitalization.

4. Causal treatment.

Depending on the cause eg, amubiasis, tuberculosis, aktinomikosis.
Treated with specific drugs for each disease.

5. Additional treatment and physiotherapy.

Aiming to improve the general situation

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