Acute Respiratory failure: Two most common causes 

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definitely. Always remember ABC and stabilize your patient. Treatment depends on the location of the fluid. If its intersitial fluid then they need an IV loop diuretic (lasix, bumex), if they are not responsive to IV lasix then aquapheresis or SCUF and if kidney failure then dialysis. If the patient has the fluid in the pleural cavity (pleural effusion) then it may be drained but not always. Patients with heart failure and who are fluid overload often have bilateral pleural effusions which respond to lasix. If its a unilateral effusion then it is more likely to be drained but liver patients can get a unilateral hydrothorax which is not uncommon. unilateral effusions can be caused by cancer or infection (TB or parapneumonic effusion). If it is complicated by cancer or infection then the patient will most likely get a chest tube after the results come back from the pleurocentesis.

AJohnson0325 I just wanted to know if the er knew there was a large pocket of fluid in the lung and she was under distressed breathing, like right to left shunting. Felt like she was choking. Her chest moved sideways on intake of air. Should this have been done immediately rather than 12 hrs or more later?

Just my thoughts but anybody with difficulty breathing should get a chest X-ray and I couldn't say definitively what the diagnosis and thus treatment would be without a history, physical, or labs and also chest X-ray in this case. If it is a large problem like fluid or air in the pleural space then chest x ray would probably pick it up but actually ct scan is a more sensitive test for pneumothoraces (plural of pneumothorax). Sorry I can't really give you a straight yes or no answer though. I can say that i would have wanted to see a chest x ray of the patient and if the etiology could be determined and it was causing a patient to become unstable then it needs to be dealt with quickly. Assuming that the patient had fluid in the pleural cavity and not something else, just having fluid in the pleural cavity does not tell you the underlying cause. Of course you would want to get rid of the fluid and expand the lung (which can sometimes be done with diuretics and sometimes needs a pleurocentesis) but you always want to treat the underlying cause and stabilize your patient as best you can. If you have any other questions feel free to ask me.

She did have x rays and other test as well and they knew there was a large pocket of fluid in the lung. But yet waited over 12 hours to finally have someone remove 2 liters. With more still in there. I believe that to be far from the standard of care a person should receive especially someone battling breast cancer showing up at the ER with severe breathing problems. Her chest was shunting I believe. Moved violently to one side while breathing for well over 12 hrs.

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