Paeds Cases · respiratory-sleep-and-airway
Explain empyema and its treatment to a worried parent — OSCE
OSCE communication and shared-planning station: explaining a parapneumonic empyema to a frightened parent, why the chest drain and fibrinolytics are needed, why the illness is taking so long, and the excellent long-term outlook.
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You are the paediatric registrar. A 4-year-old boy was admitted with pneumonia that developed into an empyema; he now has a chest drain in place and has had intrapleural fibrinolytics, and he is starting to improve. His father has ten minutes with you. He wants to understand, in plain language: (1) what an empyema is and why the pneumonia turned into this; (2) why a chest drain and "clot-busting" medicine were needed rather than just stronger antibiotics; (3) why it is all taking so long; and (4) whether his son's lungs will recover. Explain with empathy, check understanding, and agree a clear plan. [1]
References4ShowHide
- [1]Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infection in children. Thorax, 2005.PMID 15681514
- [2]Islam S, Calkins CM, Goldin AB, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg, 2012.PMID 23164006
- [3]Sonnappa S, Cohen G, Owens CM, et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med, 2006.PMID 16675783
- [4]Redden MD, Chin TY, van Driel ML. Surgical versus non-surgical management for pleural empyema. Cochrane Database Syst Rev, 2017.PMID 28304084