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Pleural effusion empyema — ABEM Board MCQ

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HardPulmonary emergenciesPleural effusion empyemaABEM Board

A 52-year-old man arrives with fever, pleuritic pain, and dyspnea after 1 week of pneumonia. Triage acuity is ESI 2; T 102.8 F, HR 122/min, RR 28/min, SpO2 91%. Ultrasound shows a large loculated pleural effusion with septations. He is ill appearing. Which of the following is the most appropriate next step in management?

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Correct answer: D — Start IV antibiotics and arrange tube thoracostomy drainage

Complicated parapneumonic effusion or empyema with loculations requires antibiotics and drainage.

Reference: IDSA/ATS pneumonia guidance; emergency ultrasound guidance