In a medical context, it is important to precise if the
pleurisy is associated with signs of tamponnade, and/or clinical presentation of ominous organic distress (acute
respiratory failure, septic, haemorragic, or
cardiogenic shock) or
pulmonary embolism. Presence of pleural tamponnade leads to immediate
decompression pleural
puncture which improves rapidly in general the clinical tolerance, and later permits etiologic treatment. In more severe conditions, pleural evacuation is done in parallel with
cardiopulmonary resuscitation maneuvers. If
hydropneumothorax is present, immediate drainage with a
chest tube will be performed. In other situations, the presence of an abundant
pleural effusion with clear fluid necessitates partial needle evacuation to authorize secondarily complementary investigations with pleural biopsy. If purulent
pleurisy is discovered, immediate evacuation of
pus is mandatory, with needle pleural lavage or
chest tube. In all cases, the pleural fluid requires complete haematological, biochemical, and cytologic as well as bacteriological analysis. In the surgical emergency ward, if an opened
wound is discovered (gun shot, blunt object or weapon), cardiocirculatory
resuscitation is often mandatory, with immediate transfer to the operation ward for an exploratory
thoracotomy. If a closed thoracic
trauma is present, the problem is generally the management of an hemo(pneumo)thorax with
chest tube drainage leading sometimes if the pleural
bleeding persists to
thoracotomy.