choose the icon next to the pleuraleffusion turn on item to the right of pleuraleffusion icon press icon at the top right corner
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612], "focused": false, "selected": false, "scrollable-vertical": false, "children": [{"scrollable-horizontal": false, "draw": true, "ancestors": ["android.view.ViewGroup", "android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [0, 252, 1440, 374], "visibility": "visible", "content-desc": [null], "rel-bounds": [0, 0, 1440, 122], "focused": false, "selected": false, "scrollable-vertical": false, "children": [{"scrollable-horizontal": false, "draw": true, "ancestors": ["android.view.ViewGroup", "android.view.View", "java.lang.Object"], "clickable": true, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [0, 252, 1440, 374], "visibility": "visible", "content-desc": [null], "rel-bounds": [0, 0, 1440, 122], "focused": false, "selected": false, "scrollable-vertical": false, "children": [{"scrollable-horizontal": false, "draw": false, "ancestors": ["android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [5, 257, 122, 369], "visibility": "visible", "content-desc": [null], "rel-bounds": [5, 5, 122, 117], "focused": false, "selected": false, "scrollable-vertical": false, "adapter-view": false, "abs-pos": true, "pointer": "2ecf2ce", "class": "android.widget.ImageView", "visible-to-user": true}, {"scrollable-horizontal": false, "draw": false, "ancestors": ["android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "text": "History", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [122, 270, 322, 355], "visibility": "visible", "content-desc": [null], "rel-bounds": [122, 18, 322, 103], "focused": false, "selected": false, "scrollable-vertical": false, "adapter-view": false, "abs-pos": true, "pointer": "a3255ef", "class": "android.widget.TextView", "visible-to-user": true}], "adapter-view": false, "abs-pos": true, "pointer": "1b48bc9", "class": "android.widget.LinearLayout", "visible-to-user": true}, {"scrollable-horizontal": false, "draw": true, "ancestors": ["android.view.ViewGroup", "android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [0, 374, 1440, 374], "visibility": "visible", "content-desc": [null], "rel-bounds": [0, 122, 1440, 2566], "focused": false, "selected": false, "scrollable-vertical": false, "children": [{"scrollable-horizontal": false, "draw": false, "ancestors": ["android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "text": "\n \u00b7 Dyspnea is the most common symptoms at presentation and usually indicates large (>500 mL) effusion \n \u00b7 pleuritic chest pain \n \u00b7 cough \n \u00b7 fever \n \u00b7 hemoptysis \n \u00b7 wt. loss \n \u00b7 trauma \n \u00b7 hx cancer \n \u00b7 cardiac surgery \n \n \n CASE \n \n CC: fever, cough and shortness of breath \n \n HPI: 34-year-old man, an active IV heroin user, presents to the Emergency Department. He was in his usual state of health until about two weeks ago when he was evaluated in the emergency room for complaints of fever, chills, pleuritic chest pain, fatigue, and a cough productive of green sputum. A chest radiograph was taken during that visit and showed a right lower lobe infiltrate, but the patient left the emergency department without the discharge paperwork or prescriptions. Multiple attempts to contact him have been unsuccessful. In the two weeks since that visit, his symptoms have worsened. \n PMH: HIV test was negative 6 months ago per patient; no surgeries. \n Medications: Acetaminophen for fevers \n Allergies: NKDA \n Social History: IV heroin use; smokes half a pack of cigarettes per day for 15 years; social alcohol use; sexually active with women. \n Family History: non-contributory \n", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [35, 374, 1440, 374], "visibility": "visible", "content-desc": [null], "rel-bounds": [35, 0, 1440, 2444], "focused": false, "selected": false, "scrollable-vertical": false, "adapter-view": false, "abs-pos": true, "pointer": "9711b85", "class": "android.widget.TextView", "visible-to-user": false}], "adapter-view": false, "abs-pos": true, "pointer": "37798fc", "class": "android.widget.LinearLayout", "visible-to-user": false}], "adapter-view": false, "abs-pos": true, "pointer": "7454fd0", "class": "com.KHALED.hxex.ExpandoLayout", "visible-to-user": 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"class": "android.widget.LinearLayout", "visible-to-user": true}, {"scrollable-horizontal": false, "draw": true, "ancestors": ["android.view.ViewGroup", "android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [0, 496, 1440, 496], "visibility": "visible", "content-desc": [null], "rel-bounds": [0, 122, 1440, 1732], "focused": false, "selected": false, "scrollable-vertical": false, "children": [{"text": "\n \u00b7 Dullness or decreased resonance to percussion \n \u00b7 Diminished or inaudible breath sounds \n \u00b7 Decreased tactile fremitus \n \u00b7 Egophony \n \u00b7 Pleural friction rub \n \u00b7 Asymmetric expansion of thoracic cage \n \u00b7 Mediastinal shift \n \u00b7 Other findings that provide clues to the cause of pleural effusion \n \n (CASE cont.) \n Physical Exam: \n VS: T 102.1; HR 110; BP 110/60; RR 20; O2 sat 92% on room air \n General: thin diaphoretic man, breathing uncomfortably, splinting. \n HEENT: no thrush; OP without lesions; normal TMs. \n Neck: supple, no LAD, JVP normal \n Lungs: egophony and dullness to percussion at the right base \n CV: tachycardic; regular; normal S1S2; no murmurs, rubs, or gallop. \n Extr: track marks on both forearms; no embolic stigmata; no c/c/e", "resource-id": "com.KHALID.hxex:id/wage", "adapter-view": false, "pointer": "6c913e7", "scrollable-horizontal": false, "ancestors": ["android.view.View", "java.lang.Object"], "selected": false, "content-desc": [null], "rel-bounds": [35, 0, 1440, 1610], "draw": false, "focusable": false, "long-clickable": false, "visibility": "visible", "focused": false, "clickable": false, "abs-pos": true, "class": "android.widget.TextView", "visible-to-user": false, "package": "com.KHALID.hxex", "enabled": true, "bounds": [35, 496, 1440, 496], "pressed": "not_pressed", "scrollable-vertical": false}], "adapter-view": false, "abs-pos": true, "pointer": "3008da6", "class": 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false, "scrollable-vertical": false, "children": [{"scrollable-horizontal": false, "draw": false, "ancestors": ["android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [5, 501, 122, 613], "visibility": "visible", "content-desc": [null], "rel-bounds": [5, 5, 122, 117], "focused": false, "selected": false, "scrollable-vertical": false, "adapter-view": false, "abs-pos": true, "pointer": "597de32", "class": "android.widget.ImageView", "visible-to-user": true}, {"scrollable-horizontal": false, "draw": false, "ancestors": ["android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "text": "Investigation", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [122, 514, 482, 599], "visibility": "visible", "content-desc": [null], "rel-bounds": [122, 18, 482, 103], "focused": false, "selected": false, "scrollable-vertical": false, "adapter-view": false, "abs-pos": true, "pointer": "4090783", "class": "android.widget.TextView", "visible-to-user": true}], "adapter-view": false, "abs-pos": true, "pointer": "87c363d", "class": "android.widget.LinearLayout", "visible-to-user": true}, {"scrollable-horizontal": false, "draw": true, "ancestors": ["android.view.ViewGroup", "android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [0, 618, 1440, 618], "visibility": "visible", "content-desc": [null], "rel-bounds": [0, 122, 1440, 2630], "focused": false, "selected": false, "scrollable-vertical": false, "children": [{"text": "\n \u25baPleural fluid analysis \n -Appearance: \n \u00b7 Bloody \n Hct less than 1percent not significant, 1-20percent= CA, PE, Trauma \n >50percent serum Hct = hemothorax \n \u00b7 Cloudy \n trig level >110mg/dl = chylothorax \n \u00b7 Putrid odor \n stain and culture = infection? \n -Transudate vs Exudate? \n Pleural fluid is exudate if one or more: \n Pleural fluid protein:serum protein > 0.5 \n Pleural fluid LDH:serum LDH > 0.6 \n Pleural fluid LDH > 2/3 upper limit nl serum LDH \n \u25baC-XRAY:obliteration of costo-phrinic angle \n \u25baCell count and differential \n - Neutrophil predominance indicates an acute inflammatory process \n - Lymphocytes indicate a chronic effusion (if >50percent rheumatoid pleurisy, chronic fungal infections, chronic TB, sarcoidosis, chylothorax) \n - Eosinophils (pneumothorax, hemothorax, infarct, parasites, meds) \n - Mesothelial cells (>5percent excludes tuberculous pleurisy) \n \u25baTotal protein level (>7 g/dL multiple myeloma and Waldenstroms should be considered) \n \u25baGlucose level \n \u25baLDH level (>1000 empyema, rheumatoid pleurisy, malignancy) \n \u25baAmylase level \n \u25bapH (low pH in empyema, malignancy, rheumatoid pleurisy, TB) \n \u25baCytologic analysis \n \u25baConsider sending pleural fluid for Gram stain and culture, AFB stain, fungal cultures \n", "resource-id": "com.KHALID.hxex:id/wsex", "adapter-view": false, "pointer": "faf939", "scrollable-horizontal": false, "ancestors": ["android.view.View", "java.lang.Object"], "selected": false, "content-desc": [null], "rel-bounds": [35, 0, 1440, 2508], "draw": false, "focusable": false, "long-clickable": false, "visibility": "visible", "focused": false, "clickable": false, "abs-pos": true, "class": "android.widget.TextView", "visible-to-user": false, "package": "com.KHALID.hxex", "enabled": true, "bounds": [35, 618, 1440, 618], "pressed": "not_pressed", "scrollable-vertical": false}], "adapter-view": false, "abs-pos": true, "pointer": "a744d00", "class": "android.widget.LinearLayout", "visible-to-user": false}], "adapter-view": false, "abs-pos": true, "pointer": "3580b94", "class": "com.KHALED.hxex.ExpandoLayout", "visible-to-user": true}, {"scrollable-horizontal": false, "draw": true, "ancestors": ["android.view.ViewGroup", "android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [0, 618, 1440, 740], "visibility": "visible", "content-desc": [null], "rel-bounds": [0, 366, 1440, 488], "focused": false, "selected": false, "scrollable-vertical": false, "children": [{"scrollable-horizontal": false, "draw": true, "ancestors": ["android.view.ViewGroup", "android.view.View", "java.lang.Object"], "clickable": true, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [0, 618, 1440, 740], "visibility": "visible", "content-desc": [null], "rel-bounds": [0, 0, 1440, 122], "focused": false, "selected": false, "scrollable-vertical": false, "children": [{"scrollable-horizontal": false, "draw": false, "ancestors": ["android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [5, 623, 122, 735], "visibility": "visible", "content-desc": [null], "rel-bounds": [5, 5, 122, 117], "focused": false, "selected": false, "scrollable-vertical": false, "adapter-view": false, "abs-pos": true, "pointer": "851392c", "class": "android.widget.ImageView", "visible-to-user": true}, {"scrollable-horizontal": false, "draw": false, "ancestors": ["android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "text": "Causes", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [122, 636, 329, 721], "visibility": "visible", "content-desc": [null], "rel-bounds": [122, 18, 329, 103], "focused": false, "selected": false, "scrollable-vertical": false, "adapter-view": false, "abs-pos": true, "pointer": "e08eff5", "class": "android.widget.TextView", "visible-to-user": true}], "adapter-view": false, "abs-pos": true, "pointer": "cca98df", "class": "android.widget.LinearLayout", "visible-to-user": true}, {"scrollable-horizontal": false, "draw": true, "ancestors": ["android.view.ViewGroup", "android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [0, 740, 1440, 740], "visibility": "visible", "content-desc": [null], "rel-bounds": [0, 122, 1440, 772], "focused": false, "selected": false, "scrollable-vertical": false, "children": [{"scrollable-horizontal": false, "draw": false, "ancestors": ["android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "text": "\n Transudate: \n \u00b7 CHF \n \u00b7 Cirrhosis \n \u00b7 Nephrotic syndrome \n \n Exudate: \n \u00b7 Pneumonia \n \u00b7 Malignancy \n \u00b7 Pulmonary Embolism", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [35, 740, 601, 740], "visibility": "visible", "content-desc": [null], "rel-bounds": [35, 0, 601, 650], "focused": false, "selected": false, "scrollable-vertical": false, "adapter-view": false, "abs-pos": true, "pointer": "8e9e3fb", "class": "android.widget.TextView", "visible-to-user": false}], "adapter-view": false, "abs-pos": true, "pointer": "f69018a", "class": "android.widget.LinearLayout", "visible-to-user": false}], "adapter-view": false, "abs-pos": true, "pointer": "de1ab7e", "class": "com.KHALED.hxex.ExpandoLayout", "visible-to-user": true}, {"scrollable-horizontal": false, "draw": true, "ancestors": ["android.view.ViewGroup", "android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [0, 740, 1440, 862], "visibility": "visible", "content-desc": [null], "rel-bounds": [0, 488, 1440, 610], "focused": false, "selected": false, "scrollable-vertical": false, "children": [{"scrollable-horizontal": false, "draw": true, "ancestors": ["android.view.ViewGroup", "android.view.View", "java.lang.Object"], "clickable": true, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [0, 740, 1440, 862], "visibility": "visible", "content-desc": [null], "rel-bounds": [0, 0, 1440, 122], "focused": false, "selected": false, "scrollable-vertical": false, "children": [{"scrollable-horizontal": false, "draw": false, "ancestors": ["android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [5, 745, 122, 857], "visibility": "visible", "content-desc": [null], "rel-bounds": [5, 5, 122, 117], "focused": false, "selected": false, "scrollable-vertical": false, "adapter-view": false, "abs-pos": true, "pointer": "95dac56", "class": "android.widget.ImageView", "visible-to-user": true}, {"scrollable-horizontal": false, "draw": false, "ancestors": ["android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "text": "Treatment", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [122, 758, 410, 843], "visibility": "visible", "content-desc": [null], "rel-bounds": [122, 18, 410, 103], "focused": false, "selected": false, "scrollable-vertical": false, "adapter-view": false, "abs-pos": true, "pointer": "7e8c4d7", "class": "android.widget.TextView", "visible-to-user": true}], "adapter-view": false, "abs-pos": true, "pointer": "9c59671", "class": "android.widget.LinearLayout", "visible-to-user": true}, {"scrollable-horizontal": false, "draw": true, "ancestors": ["android.view.ViewGroup", "android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [0, 862, 1440, 862], "visibility": "visible", "content-desc": [null], "rel-bounds": [0, 122, 1440, 1606], "focused": false, "selected": false, "scrollable-vertical": false, "children": [{"scrollable-horizontal": false, "draw": false, "ancestors": ["android.view.View", "java.lang.Object"], "clickable": false, "pressed": "not_pressed", "text": "\n Transudative effusion -\u25ba treat underlying disease process. \n Exudative pleural effusion -\u25ba management depends on etiology. \n Symptomatic pleural effusion \u25ba therapeutic thoracentesis. \n \n Uncomplicated parapneumonic effusions generally resolve with antibiotics alone. \n - Aminoglycosides are inactivated at low pleural pH. \n \n Complicated parapneumonic effusions or empyema require drainage in addition to antibiotic therapy. \n - Tube thoracostomy \n - Fibrinolytics \n - Thoracoscopy \n - Open thoracostomy \n - Decortication \n \n Malignant pleural effusion: serial thoracentesis; tube thoracostomy; and/or pleurodesis. \n", "focusable": false, "long-clickable": false, "enabled": true, "bounds": [35, 862, 1440, 862], "visibility": "visible", "content-desc": [null], "rel-bounds": [35, 0, 1440, 1484], "focused": false, "selected": false, "scrollable-vertical": false, "adapter-view": false, "abs-pos": true, "pointer": "6cc28ad", "class": "android.widget.TextView", "visible-to-user": false}], "adapter-view": 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