The EM Educator Series: Empyema – Does this “pneumonia” need source control?

Author: Alex Koyfman, MD (@EMHighAK) // Reviewed by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case 1:

A 33-year-old female with a recent admission for large hemothorax after an MVC returns with shortness of breath and fever.

Case 2:

A 45-year-old male presents with fatigue, fever, chills, chest pain, and shortness of breath. He was diagnosed with pneumonia several weeks ago and treated with antibiotics, but he states his symptoms have worsened. He is hypotensive and febrile on exam, and chest x-ray reveals a moderate pleural effusion on the left.

Considerations:

• What is an empyema?
• What are the risk factors for empyema?
• How can patients present?
• What tests should we perform in the ED?
• What is the recommended treatment?

Suggested Resources: 

• Articles
  • emDOCs – Empyema
  • emDOCs – Pleural Effusion
• Journal Articles
  • https://pubmed.ncbi.nlm.nih.gov/31525811/ 
  • https://pubmed.ncbi.nlm.nih.gov/28274565/