eMedicine Specialties > Emergency Medicine > Pulmonary

Pneumonia, Empyema and Abscess: Follow-up

Author: Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Contributor Information and Disclosures

Updated: Nov 25, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is mandatory for the management and assistance of the patient's respiratory status, continuation of intravenous antibiotics, and drainage of the lung abscess or empyema as needed.

Inpatient & Outpatient Medications

  • Outpatient therapy for lung abscess or empyema is not indicated or advised; inpatient care is mandatory.
  • Antimicrobial therapy should be continued empirically until therapy can be guided with culture results.

Transfer

  • Transfer of these patients usually is not indicated unless advanced respiratory management or surgical drainage is not available without transfer.
  • Patients should be transferred only after stabilization of their respiratory status and administration of intravenous antibiotics.

Deterrence/Prevention

  • Prevention of aspiration is important to minimize the subsequent risk of lung abscess.
  • Early intubation should be performed in patients who do not have a gag reflex.
  • Position the patient in a manner that minimizes the risk of aspiration. For example, a patient who is vomiting should be placed on his or her side.
  • Immediately suction the patient's orotracheal area if he or she aspirates in the ED.

Complications

  • Complications of pulmonary abscess include pleural fibrosis, trapped lung, restrictive ventilatory defect, bronchopleural fistula, and pleurocutaneous fistula.

Prognosis

  • The prognosis for both lung abscess and empyema generally is good. Ninety percent of lung abscesses are cured with medical management alone.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to suspect the diagnosis
  • Failure to perform thoracentesis for a pleural effusion: The fluid results assist in the treatment of the patient by allowing differentiation of an empyema and parapneumonic effusion. Empyema requires chest tube placement while a simple parapneumonic effusion can be treated with intravenous antibiotics alone.
 


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References
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Further Reading

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Keywords

empyema, empyema treatment, empyema causes, aspiration, lung abscess, lung abscess treatment, lung abscess causes, lung abscess symptoms, lung infection, pleural pus, subdiaphragmatic abscess, paravertebral abscess

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Contributor Information and Disclosures

Author

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Medicines Company Consulting fee Consulting; Pfizer Salary Employment

Medical Editor

Mark S Slabinski, MD, FACEP, FAAEM, Vice President, EMP Medical Group
Mark S Slabinski, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Ohio State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Paul Blackburn, DO, FACOEP, FACEP, Program Director, Department of Emergency Medicine, Maricopa Medical Center; Assistant Professor, Department of Surgery, University of Arizona
Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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