{"version":"1.0.0","segments":[{"startTime":0.311,"endTime":3.22,"body":"[upbeat intro music]"},{"startTime":3.22,"endTime":5.6,"body":"[Dr. Handy] Hi, welcome"},{"startTime":3.22,"endTime":5.6,"body":"to Harrison's Podclass"},{"startTime":5.6,"endTime":8.73,"body":"where we discuss important"},{"startTime":5.6,"endTime":8.73,"body":"concepts in internal medicine."},{"startTime":8.73,"endTime":9.85,"body":"I'm Cathy Handy."},{"startTime":9.85,"endTime":11.64,"body":"[Dr. Wiener] And I'm Charlie"},{"startTime":9.85,"endTime":11.64,"body":"Wiener and we're coming to you"},{"startTime":11.64,"endTime":13.74,"body":"from the Johns Hopkins School of Medicine."},{"speaker":"Welcome to episode 51","startTime":17.623,"endTime":21.94,"body":"A 57-Year-Old with Dyspnea"},{"speaker":"Welcome to episode 51","startTime":17.623,"endTime":21.94,"body":"and Lower Extremity Edema."},{"speaker":"Welcome to episode 51","startTime":21.94,"endTime":24.54,"body":"Okay, Cathy, here's the question."},{"speaker":"Welcome to episode 51","startTime":24.54,"endTime":26.55,"body":"A 57-year-old man with a known history"},{"speaker":"Welcome to episode 51","startTime":26.55,"endTime":28.22,"body":"of congestive heart failure presents"},{"speaker":"Welcome to episode 51","startTime":28.22,"endTime":30.41,"body":"to the emergency department"},{"speaker":"Welcome to episode 51","startTime":28.22,"endTime":30.41,"body":"with increasing dyspnea"},{"speaker":"Welcome to episode 51","startTime":30.41,"endTime":33.81,"body":"and lower extremity edema"},{"speaker":"Welcome to episode 51","startTime":30.41,"endTime":33.81,"body":"over the past few weeks."},{"speaker":"Welcome to episode 51","startTime":33.81,"endTime":36.8,"body":"On exam, he has an elevated"},{"speaker":"Welcome to episode 51","startTime":33.81,"endTime":36.8,"body":"jugular venous pressure"},{"speaker":"Welcome to episode 51","startTime":36.8,"endTime":39.73,"body":"and bilateral lower"},{"speaker":"Welcome to episode 51","startTime":36.8,"endTime":39.73,"body":"extremity pitting edema."},{"speaker":"Welcome to episode 51","startTime":39.73,"endTime":41.57,"body":"He also has dullness to percussion,"},{"speaker":"Welcome to episode 51","startTime":41.57,"endTime":43.73,"body":"decreased tactile fremitus"},{"speaker":"Welcome to episode 51","startTime":43.73,"endTime":47.02,"body":"and decreased breath"},{"speaker":"Welcome to episode 51","startTime":43.73,"endTime":47.02,"body":"sounds at his right base."},{"speaker":"Welcome to episode 51","startTime":47.02,"endTime":49.25,"body":"A chest radiograph reveals a moderate size"},{"speaker":"Welcome to episode 51","startTime":49.25,"endTime":52.93,"body":"right pleural effusion, a"},{"speaker":"Welcome to episode 51","startTime":49.25,"endTime":52.93,"body":"small left pleural effusion"},{"speaker":"Welcome to episode 51","startTime":52.93,"endTime":55.07,"body":"and pulmonary vascular congestion."},{"speaker":"Welcome to episode 51","startTime":55.07,"endTime":58.69,"body":"He's afebrile and denies"},{"speaker":"Welcome to episode 51","startTime":55.07,"endTime":58.69,"body":"any chest discomfort."},{"speaker":"Welcome to episode 51","startTime":58.69,"endTime":59.81,"body":"His breathing improves"},{"speaker":"Welcome to episode 51","startTime":59.81,"endTime":62.27,"body":"with an intravenous dose of furosemide."},{"speaker":"Welcome to episode 51","startTime":62.27,"endTime":63.103,"body":"[Dr. Handy] All right, that's good."},{"speaker":"Welcome to episode 51","startTime":63.103,"endTime":64.61,"body":"If the question was about management,"},{"speaker":"Welcome to episode 51","startTime":64.61,"endTime":66.69,"body":"I was going to suggest IV furosemide"},{"speaker":"Welcome to episode 51","startTime":66.69,"endTime":69.22,"body":"as the treatment for"},{"speaker":"Welcome to episode 51","startTime":66.69,"endTime":69.22,"body":"decompensated heart failure."},{"speaker":"Welcome to episode 51","startTime":69.22,"endTime":72.52,"body":"[Dr. Wiener] Well, that's not"},{"speaker":"Welcome to episode 51","startTime":69.22,"endTime":72.52,"body":"the question, there is more."},{"speaker":"Welcome to episode 51","startTime":72.52,"endTime":75.65,"body":"So a right sided"},{"speaker":"Welcome to episode 51","startTime":72.52,"endTime":75.65,"body":"thoracentesis is performed"},{"speaker":"Welcome to episode 51","startTime":75.65,"endTime":79.759,"body":"and pleural fluid analysis"},{"speaker":"Welcome to episode 51","startTime":75.65,"endTime":79.759,"body":"reveals a pH of 7.42,"},{"speaker":"Welcome to episode 51","startTime":79.759,"endTime":83.54,"body":"an LDH of 280, a pleural fluid protein"},{"speaker":"Welcome to episode 51","startTime":83.54,"endTime":88.18,"body":"of four milligrams per deciliter"},{"speaker":"Welcome to episode 51","startTime":83.54,"endTime":88.18,"body":"and 400 white blood cells"},{"speaker":"Welcome to episode 51","startTime":88.18,"endTime":90.35,"body":"all of them mononuclear."},{"speaker":"Welcome to episode 51","startTime":90.35,"endTime":93.895,"body":"Serum protein at the same"},{"speaker":"Welcome to episode 51","startTime":90.35,"endTime":93.895,"body":"time as his thoracentesis"},{"speaker":"Welcome to episode 51","startTime":93.895,"endTime":96.42,"body":"is 7.5 milligrams per deciliter"},{"speaker":"Welcome to episode 51","startTime":96.42,"endTime":99.03,"body":"and his serum LDH is 600."},{"speaker":"Welcome to episode 51","startTime":99.03,"endTime":100.93,"body":"[Dr. Handy] Interesting,"},{"speaker":"Welcome to episode 51","startTime":99.03,"endTime":100.93,"body":"I'm not sure actually"},{"speaker":"Welcome to episode 51","startTime":100.93,"endTime":102.33,"body":"I would have done a thoracentesis"},{"speaker":"Welcome to episode 51","startTime":102.33,"endTime":103.94,"body":"in this person immediately."},{"speaker":"Welcome to episode 51","startTime":103.94,"endTime":106.16,"body":"Certainly if his breathing"},{"speaker":"Welcome to episode 51","startTime":103.94,"endTime":106.16,"body":"wasn't getting any better"},{"speaker":"Welcome to episode 51","startTime":106.16,"endTime":108.57,"body":"you could do one for therapeutic purposes."},{"speaker":"Welcome to episode 51","startTime":108.57,"endTime":111.4,"body":"I guess it's reasonable on this"},{"speaker":"Welcome to episode 51","startTime":108.57,"endTime":111.4,"body":"case for diagnostic purposes"},{"speaker":"Welcome to episode 51","startTime":111.4,"endTime":113.58,"body":"because you mentioned that it's asymmetric"},{"speaker":"Welcome to episode 51","startTime":113.58,"endTime":115.96,"body":"but if it were bilateral, I"},{"speaker":"Welcome to episode 51","startTime":113.58,"endTime":115.96,"body":"don't think I would've done it"},{"speaker":"Welcome to episode 51","startTime":115.96,"endTime":118.18,"body":"because the most common"},{"speaker":"Welcome to episode 51","startTime":115.96,"endTime":118.18,"body":"cause of pleural effusions"},{"speaker":"Welcome to episode 51","startTime":118.18,"endTime":121.13,"body":"are left ventricular failure"},{"speaker":"Welcome to episode 51","startTime":118.18,"endTime":121.13,"body":"and we know by his history"},{"speaker":"Welcome to episode 51","startTime":121.13,"endTime":122.58,"body":"that he has heart failure."},{"speaker":"Welcome to episode 51","startTime":122.58,"endTime":124.23,"body":"[Dr. Wiener] Okay, well,"},{"speaker":"Welcome to episode 51","startTime":122.58,"endTime":124.23,"body":"given that it was done,"},{"speaker":"Welcome to episode 51","startTime":124.23,"endTime":125.6,"body":"how do you interpret the results?"},{"speaker":"Welcome to episode 51","startTime":125.6,"endTime":127.76,"body":"And did we learn anything"},{"speaker":"Welcome to episode 51","startTime":125.6,"endTime":127.76,"body":"new from the test?"},{"speaker":"Welcome to episode 51","startTime":127.76,"endTime":129.29,"body":"[Dr. Handy] Well, let's take"},{"speaker":"Welcome to episode 51","startTime":127.76,"endTime":129.29,"body":"a step back and talk about"},{"speaker":"Welcome to episode 51","startTime":129.29,"endTime":132.14,"body":"the pathophysiology to"},{"speaker":"Welcome to episode 51","startTime":129.29,"endTime":132.14,"body":"distinguish transudative"},{"speaker":"Welcome to episode 51","startTime":132.14,"endTime":135.42,"body":"versus exudative pleural"},{"speaker":"Welcome to episode 51","startTime":132.14,"endTime":135.42,"body":"effusions mechanistically."},{"speaker":"Welcome to episode 51","startTime":135.42,"endTime":137.84,"body":"Transudates are typically"},{"speaker":"Welcome to episode 51","startTime":135.42,"endTime":137.84,"body":"benign and are caused"},{"speaker":"Welcome to episode 51","startTime":137.84,"endTime":140.61,"body":"by systemic factors that"},{"speaker":"Welcome to episode 51","startTime":137.84,"endTime":140.61,"body":"promote fluid transudation"},{"speaker":"Welcome to episode 51","startTime":140.61,"endTime":142.33,"body":"into the pleural space."},{"speaker":"Welcome to episode 51","startTime":142.33,"endTime":145.67,"body":"Usual causes are an elevated"},{"speaker":"Welcome to episode 51","startTime":142.33,"endTime":145.67,"body":"pulmonary capillary pressure"},{"speaker":"Welcome to episode 51","startTime":145.67,"endTime":149.12,"body":"such as in heart failure or a"},{"speaker":"Welcome to episode 51","startTime":145.67,"endTime":149.12,"body":"reduced serum oncotic pressure"},{"speaker":"Welcome to episode 51","startTime":149.12,"endTime":150.93,"body":"such as in cirrhosis."},{"speaker":"Welcome to episode 51","startTime":150.93,"endTime":153.33,"body":"In contrast, exudates are the result"},{"speaker":"Welcome to episode 51","startTime":153.33,"endTime":155.43,"body":"of local factors such as inflammation"},{"speaker":"Welcome to episode 51","startTime":155.43,"endTime":157.92,"body":"or malignancy that"},{"speaker":"Welcome to episode 51","startTime":155.43,"endTime":157.92,"body":"allow protein-rich fluid"},{"speaker":"Welcome to episode 51","startTime":157.92,"endTime":159.96,"body":"to build up in the pleural space."},{"speaker":"Welcome to episode 51","startTime":159.96,"endTime":163.06,"body":"The most common causes of"},{"speaker":"Welcome to episode 51","startTime":159.96,"endTime":163.06,"body":"exudates are pneumonia, cancers"},{"speaker":"Welcome to episode 51","startTime":163.06,"endTime":164.67,"body":"or pulmonary emboli."},{"speaker":"Welcome to episode 51","startTime":164.67,"endTime":166.04,"body":"[Dr. Wiener] And how do we use the labs"},{"speaker":"Welcome to episode 51","startTime":166.04,"endTime":168.58,"body":"to distinguish transudates from exudates?"},{"speaker":"Welcome to episode 51","startTime":168.58,"endTime":172.31,"body":"[Dr. Handy] In 1972, Richard"},{"speaker":"Welcome to episode 51","startTime":168.58,"endTime":172.31,"body":"Light, a former Oslo resident"},{"speaker":"Welcome to episode 51","startTime":172.31,"endTime":175.21,"body":"at Johns Hopkins Hospital"},{"speaker":"Welcome to episode 51","startTime":172.31,"endTime":175.21,"body":"and colleagues published"},{"speaker":"Welcome to episode 51","startTime":175.21,"endTime":177.22,"body":"a clinical trial that defines criteria"},{"speaker":"Welcome to episode 51","startTime":177.22,"endTime":179.61,"body":"to distinguish transudative"},{"speaker":"Welcome to episode 51","startTime":177.22,"endTime":179.61,"body":"pleural effusions"},{"speaker":"Welcome to episode 51","startTime":179.61,"endTime":181.81,"body":"from exudative pleural effusions."},{"speaker":"Welcome to episode 51","startTime":181.81,"endTime":184.38,"body":"These criteria which have"},{"speaker":"Welcome to episode 51","startTime":181.81,"endTime":184.38,"body":"stood the test of time,"},{"speaker":"Welcome to episode 51","startTime":184.38,"endTime":186.69,"body":"say that a pleural effusion is exudative"},{"speaker":"Welcome to episode 51","startTime":186.69,"endTime":189.73,"body":"if any of the following"},{"speaker":"Welcome to episode 51","startTime":186.69,"endTime":189.73,"body":"three criteria are met."},{"speaker":"Welcome to episode 51","startTime":189.73,"endTime":193.27,"body":"So the three criteria which are"},{"speaker":"Welcome to episode 51","startTime":189.73,"endTime":193.27,"body":"called Light's criteria now:"},{"speaker":"Welcome to episode 51","startTime":193.27,"endTime":197.59,"body":"a pleural fluid LDH to serum"},{"speaker":"Welcome to episode 51","startTime":193.27,"endTime":197.59,"body":"LDH ratio that's greater"},{"speaker":"Welcome to episode 51","startTime":197.59,"endTime":202.38,"body":"than 0.6, plural fluid"},{"speaker":"Welcome to episode 51","startTime":197.59,"endTime":202.38,"body":"protein to serum protein ratio"},{"speaker":"Welcome to episode 51","startTime":202.38,"endTime":206.07,"body":"that's greater than 0.5,"},{"speaker":"Welcome to episode 51","startTime":202.38,"endTime":206.07,"body":"or pleural fluid LDH"},{"speaker":"Welcome to episode 51","startTime":206.07,"endTime":208.44,"body":"that's greater than two"},{"speaker":"Welcome to episode 51","startTime":206.07,"endTime":208.44,"body":"thirds the upper limit"},{"speaker":"Welcome to episode 51","startTime":208.44,"endTime":210.93,"body":"of normal for the serum LDH."},{"speaker":"Welcome to episode 51","startTime":210.93,"endTime":212.255,"body":"[Dr. Wiener] So how would you interpret"},{"speaker":"Welcome to episode 51","startTime":212.255,"endTime":214.388,"body":"the results in this case?"},{"speaker":"Welcome to episode 51","startTime":214.388,"endTime":216.85,"body":"[Dr. Handy] In this case,"},{"speaker":"Welcome to episode 51","startTime":214.388,"endTime":216.85,"body":"since the pleural fluid protein"},{"speaker":"Welcome to episode 51","startTime":216.85,"endTime":220.48,"body":"is 4.8 and the serum protein is 7.5,"},{"speaker":"Welcome to episode 51","startTime":220.48,"endTime":222.79,"body":"this effusion would be"},{"speaker":"Welcome to episode 51","startTime":220.48,"endTime":222.79,"body":"classified as an exudate"},{"speaker":"Welcome to episode 51","startTime":222.79,"endTime":226.07,"body":"because the ratio is"},{"speaker":"Welcome to episode 51","startTime":222.79,"endTime":226.07,"body":"greater than half or 0.5."},{"speaker":"Welcome to episode 51","startTime":226.07,"endTime":228.96,"body":"It doesn't meet the"},{"speaker":"Welcome to episode 51","startTime":226.07,"endTime":228.96,"body":"other criteria with LDH."},{"speaker":"Welcome to episode 51","startTime":228.96,"endTime":230.76,"body":"[Dr. Wiener] But meeting"},{"speaker":"Welcome to episode 51","startTime":228.96,"endTime":230.76,"body":"one criteria is enough?"},{"speaker":"Welcome to episode 51","startTime":230.76,"endTime":231.593,"body":"[Dr. Handy] Exactly."},{"speaker":"Welcome to episode 51","startTime":231.593,"endTime":234.26,"body":"[Dr. Wiener] Okay, so"},{"speaker":"Welcome to episode 51","startTime":231.593,"endTime":234.26,"body":"the question now asks"},{"speaker":"Welcome to episode 51","startTime":234.26,"endTime":235.56,"body":"based on these results,"},{"speaker":"Welcome to episode 51","startTime":235.56,"endTime":237.59,"body":"you would recommend the following,"},{"speaker":"Welcome to episode 51","startTime":237.59,"endTime":239.88,"body":"option A is continued management"},{"speaker":"Welcome to episode 51","startTime":239.88,"endTime":241.505,"body":"for congestive heart failure,"},{"speaker":"Welcome to episode 51","startTime":241.505,"endTime":243.56,"body":"the effusion is likely a transudate"},{"speaker":"Welcome to episode 51","startTime":243.56,"endTime":246.35,"body":"that has been misclassified as an exudate;"},{"speaker":"Welcome to episode 51","startTime":246.35,"endTime":249.19,"body":"option B says, intravenous antibiotics"},{"speaker":"Welcome to episode 51","startTime":249.19,"endTime":252.447,"body":"for possible pneumonia and"},{"speaker":"Welcome to episode 51","startTime":249.19,"endTime":252.447,"body":"apparent pneumonic effusion;"},{"speaker":"Welcome to episode 51","startTime":252.447,"endTime":255.51,"body":"option C is a large bore"},{"speaker":"Welcome to episode 51","startTime":252.447,"endTime":255.51,"body":"chest tube placement"},{"speaker":"Welcome to episode 51","startTime":255.51,"endTime":258.55,"body":"on the right side with the"},{"speaker":"Welcome to episode 51","startTime":255.51,"endTime":258.55,"body":"installation of doxycycline"},{"speaker":"Welcome to episode 51","startTime":258.55,"endTime":261.52,"body":"to prevent fluid reaccumulation;"},{"speaker":"Welcome to episode 51","startTime":261.52,"endTime":264.56,"body":"option D is a thoracentesis"},{"speaker":"Welcome to episode 51","startTime":261.52,"endTime":264.56,"body":"on the left side"},{"speaker":"Welcome to episode 51","startTime":264.56,"endTime":268.01,"body":"to make sure that the left"},{"speaker":"Welcome to episode 51","startTime":264.56,"endTime":268.01,"body":"side is not also exudative;"},{"speaker":"Welcome to episode 51","startTime":268.01,"endTime":271.04,"body":"or E, thoracoscopy and pleural biopsy"},{"speaker":"Welcome to episode 51","startTime":271.04,"endTime":273.47,"body":"to exclude malignancy or tuberculosis"},{"speaker":"Welcome to episode 51","startTime":273.47,"endTime":276.98,"body":"as the cause of the exudative"},{"speaker":"Welcome to episode 51","startTime":273.47,"endTime":276.98,"body":"effusion is on the right side."},{"speaker":"Welcome to episode 51","startTime":276.98,"endTime":278.1,"body":"[Dr. Handy] Right, this"},{"speaker":"Welcome to episode 51","startTime":276.98,"endTime":278.1,"body":"is a good question,"},{"speaker":"Welcome to episode 51","startTime":278.1,"endTime":279.41,"body":"I think the answer is A"},{"speaker":"Welcome to episode 51","startTime":279.41,"endTime":281.21,"body":"and this is a good point to bring up."},{"speaker":"Welcome to episode 51","startTime":281.21,"endTime":284.31,"body":"So I already mentioned"},{"speaker":"Welcome to episode 51","startTime":281.21,"endTime":284.31,"body":"that he has heart failure"},{"speaker":"Welcome to episode 51","startTime":284.31,"endTime":285.78,"body":"and I think that that's the cause"},{"speaker":"Welcome to episode 51","startTime":285.78,"endTime":287.86,"body":"of the fluid builds up in him."},{"speaker":"Welcome to episode 51","startTime":287.86,"endTime":290.89,"body":"So I think that this is"},{"speaker":"Welcome to episode 51","startTime":287.86,"endTime":290.89,"body":"truly a transudative effusion"},{"speaker":"Welcome to episode 51","startTime":290.89,"endTime":292.91,"body":"that's been misclassified."},{"speaker":"Welcome to episode 51","startTime":292.91,"endTime":294.46,"body":"In this case, some people might think"},{"speaker":"Welcome to episode 51","startTime":294.46,"endTime":297.77,"body":"to also measure for BNP, or"},{"speaker":"Welcome to episode 51","startTime":294.46,"endTime":297.77,"body":"brain natriuretic peptides"},{"speaker":"Welcome to episode 51","startTime":297.77,"endTime":299.19,"body":"but that's not well established"},{"speaker":"Welcome to episode 51","startTime":299.19,"endTime":300.79,"body":"so it's reasonable to do in the blood"},{"speaker":"Welcome to episode 51","startTime":300.79,"endTime":303.21,"body":"but would not add it"},{"speaker":"Welcome to episode 51","startTime":300.79,"endTime":303.21,"body":"on to pleural studies."},{"speaker":"Welcome to episode 51","startTime":303.21,"endTime":304.768,"body":"[Dr. Wiener] So why do"},{"speaker":"Welcome to episode 51","startTime":303.21,"endTime":304.768,"body":"you think this effusion"},{"speaker":"Welcome to episode 51","startTime":304.768,"endTime":305.934,"body":"has been misclassified"},{"speaker":"Welcome to episode 51","startTime":305.934,"endTime":308.65,"body":"and how do you reconcile"},{"speaker":"Welcome to episode 51","startTime":305.934,"endTime":308.65,"body":"that with Light's criteria?"},{"speaker":"Welcome to episode 51","startTime":308.65,"endTime":310.188,"body":"[Dr. Handy] While Light's"},{"speaker":"Welcome to episode 51","startTime":308.65,"endTime":310.188,"body":"criteria almost never"},{"speaker":"Welcome to episode 51","startTime":310.188,"endTime":313.71,"body":"misclassifies an exudative"},{"speaker":"Welcome to episode 51","startTime":310.188,"endTime":313.71,"body":"effusion as a transudate,"},{"speaker":"Welcome to episode 51","startTime":313.71,"endTime":317.25,"body":"about 25% of transudates"},{"speaker":"Welcome to episode 51","startTime":313.71,"endTime":317.25,"body":"may be misclassified"},{"speaker":"Welcome to episode 51","startTime":317.25,"endTime":320.4,"body":"as an exudate, like what"},{"speaker":"Welcome to episode 51","startTime":317.25,"endTime":320.4,"body":"happened in this scenario."},{"speaker":"Welcome to episode 51","startTime":320.4,"endTime":323.15,"body":"So this patient's presentation"},{"speaker":"Welcome to episode 51","startTime":320.4,"endTime":323.15,"body":"including improvement"},{"speaker":"Welcome to episode 51","startTime":323.15,"endTime":325.48,"body":"from furosemide suggests"},{"speaker":"Welcome to episode 51","startTime":323.15,"endTime":325.48,"body":"that his effusions"},{"speaker":"Welcome to episode 51","startTime":325.48,"endTime":327.47,"body":"are from congestive heart failure."},{"speaker":"Welcome to episode 51","startTime":327.47,"endTime":329.91,"body":"The administration of"},{"speaker":"Welcome to episode 51","startTime":327.47,"endTime":329.91,"body":"diuretics might increase"},{"speaker":"Welcome to episode 51","startTime":329.91,"endTime":332.04,"body":"the likelihood of a transudative effusion"},{"speaker":"Welcome to episode 51","startTime":332.04,"endTime":335.35,"body":"from heart failure being"},{"speaker":"Welcome to episode 51","startTime":332.04,"endTime":335.35,"body":"misclassified as an exudate."},{"speaker":"Welcome to episode 51","startTime":335.35,"endTime":337.79,"body":"The serum protein to"},{"speaker":"Welcome to episode 51","startTime":335.35,"endTime":337.79,"body":"fluid protein gradient,"},{"speaker":"Welcome to episode 51","startTime":337.79,"endTime":339.86,"body":"greater than three"},{"speaker":"Welcome to episode 51","startTime":337.79,"endTime":339.86,"body":"milligrams per deciliter"},{"speaker":"Welcome to episode 51","startTime":339.86,"endTime":342.24,"body":"in this case argues that"},{"speaker":"Welcome to episode 51","startTime":339.86,"endTime":342.24,"body":"this effusion most likely"},{"speaker":"Welcome to episode 51","startTime":342.24,"endTime":343.24,"body":"is a transudate."},{"speaker":"Welcome to episode 51","startTime":343.24,"endTime":344.65,"body":"And the difference between the serum"},{"speaker":"Welcome to episode 51","startTime":344.65,"endTime":347.23,"body":"and pleural fluid protein"},{"speaker":"Welcome to episode 51","startTime":344.65,"endTime":347.23,"body":"would typically be less"},{"speaker":"Welcome to episode 51","startTime":347.23,"endTime":349.04,"body":"in an exudative process."},{"speaker":"Welcome to episode 51","startTime":349.04,"endTime":351.52,"body":"Also the pleural fluid"},{"speaker":"Welcome to episode 51","startTime":349.04,"endTime":351.52,"body":"white blood cell count being"},{"speaker":"Welcome to episode 51","startTime":351.52,"endTime":354.04,"body":"less than a 1,000 also"},{"speaker":"Welcome to episode 51","startTime":351.52,"endTime":354.04,"body":"argues that this is not due"},{"speaker":"Welcome to episode 51","startTime":354.04,"endTime":356.26,"body":"to an inflammatory process."},{"speaker":"Welcome to episode 51","startTime":356.26,"endTime":358.13,"body":"One could make the"},{"speaker":"Welcome to episode 51","startTime":356.26,"endTime":358.13,"body":"argument that the effusion"},{"speaker":"Welcome to episode 51","startTime":358.13,"endTime":360.07,"body":"did not need to be"},{"speaker":"Welcome to episode 51","startTime":358.13,"endTime":360.07,"body":"sampled in the first place"},{"speaker":"Welcome to episode 51","startTime":360.07,"endTime":361.62,"body":"if the patient was clinically improving"},{"speaker":"Welcome to episode 51","startTime":361.62,"endTime":363.09,"body":"with management of heart failure"},{"speaker":"Welcome to episode 51","startTime":363.09,"endTime":364.93,"body":"with the IV furosemide."},{"speaker":"Welcome to episode 51","startTime":364.93,"endTime":366.9,"body":"There's no need for more"},{"speaker":"Welcome to episode 51","startTime":364.93,"endTime":366.9,"body":"aggressive diagnostic"},{"speaker":"Welcome to episode 51","startTime":366.9,"endTime":368.11,"body":"or therapeutic procedures"},{"speaker":"Welcome to episode 51","startTime":368.11,"endTime":369.98,"body":"for a heart failure-related"},{"speaker":"Welcome to episode 51","startTime":368.11,"endTime":369.98,"body":"pleural effusion"},{"speaker":"Welcome to episode 51","startTime":369.98,"endTime":372.01,"body":"if the patient is improving clinically."},{"speaker":"Welcome to episode 51","startTime":372.01,"endTime":374.14,"body":"[Dr. Wiener] What did you"},{"speaker":"Welcome to episode 51","startTime":372.01,"endTime":374.14,"body":"think about the other options?"},{"speaker":"Welcome to episode 51","startTime":374.14,"endTime":375.86,"body":"[Dr. Handy] So I don't think"},{"speaker":"Welcome to episode 51","startTime":374.14,"endTime":375.86,"body":"that this is an infection"},{"speaker":"Welcome to episode 51","startTime":375.86,"endTime":377.93,"body":"or a malignancy and the"},{"speaker":"Welcome to episode 51","startTime":375.86,"endTime":377.93,"body":"history and physical"},{"speaker":"Welcome to episode 51","startTime":377.93,"endTime":379.72,"body":"that you mentioned does not support that."},{"speaker":"Welcome to episode 51","startTime":379.72,"endTime":382.77,"body":"So all the other answers"},{"speaker":"Welcome to episode 51","startTime":379.72,"endTime":382.77,"body":"address the diagnosis"},{"speaker":"Welcome to episode 51","startTime":382.77,"endTime":385.19,"body":"or management of either"},{"speaker":"Welcome to episode 51","startTime":382.77,"endTime":385.19,"body":"infection or malignancy"},{"speaker":"Welcome to episode 51","startTime":385.19,"endTime":386.87,"body":"so I would rule those out."},{"speaker":"Welcome to episode 51","startTime":386.87,"endTime":388.59,"body":"[Dr. Wiener] So the teaching point here"},{"speaker":"Welcome to episode 51","startTime":388.59,"endTime":391.63,"body":"is that Light's criteria"},{"speaker":"Welcome to episode 51","startTime":388.59,"endTime":391.63,"body":"will almost never misclassify"},{"speaker":"Welcome to episode 51","startTime":391.63,"endTime":394.21,"body":"an exudate as a transudate"},{"speaker":"Welcome to episode 51","startTime":391.63,"endTime":394.21,"body":"but there are circumstances"},{"speaker":"Welcome to episode 51","startTime":394.21,"endTime":397.05,"body":"where a clinical transudate"},{"speaker":"Welcome to episode 51","startTime":394.21,"endTime":397.05,"body":"may be classified"},{"speaker":"Welcome to episode 51","startTime":397.05,"endTime":399.27,"body":"by the criteria as an exudate."},{"speaker":"Welcome to episode 51","startTime":399.27,"endTime":401.86,"body":"Understanding the pathophysiology"},{"speaker":"Welcome to episode 51","startTime":399.27,"endTime":401.86,"body":"of pleural effusions"},{"speaker":"Welcome to episode 51","startTime":401.86,"endTime":403.95,"body":"and the limitations of lab testing"},{"speaker":"Welcome to episode 51","startTime":403.95,"endTime":406.42,"body":"will help manage the"},{"speaker":"Welcome to episode 51","startTime":403.95,"endTime":406.42,"body":"patient appropriately."},{"speaker":"Welcome to episode 51","startTime":406.42,"endTime":408.01,"body":"[Dr. Handy] And to learn"},{"speaker":"Welcome to episode 51","startTime":406.42,"endTime":408.01,"body":"more, you can check out"},{"speaker":"Welcome to episode 51","startTime":408.01,"endTime":411.55,"body":"the chapter on diagnostic"},{"speaker":"Welcome to episode 51","startTime":408.01,"endTime":411.55,"body":"procedures in respiratory disease"},{"speaker":"Welcome to episode 51","startTime":411.55,"endTime":414.208,"body":"and also the chapter on"},{"speaker":"Welcome to episode 51","startTime":411.55,"endTime":414.208,"body":"disorders of the pleura."},{"speaker":"Welcome to episode 51","startTime":414.208,"endTime":416.474,"body":"[outro music]"},{"speaker":"Welcome to episode 51","startTime":418.64,"endTime":419.807,"body":"[Mr. Shanahan] This is James Shanahan,"},{"speaker":"Welcome to episode 51","startTime":419.807,"endTime":421.498,"body":"publisher at McGraw Hill."},{"speaker":"Welcome to episode 51","startTime":421.498,"endTime":423.12,"body":"Harrison's Podclass is brought to you"},{"speaker":"Welcome to episode 51","startTime":423.12,"endTime":425.1,"body":"by McGraw Hill's Access Medicine."},{"speaker":"Welcome to episode 51","startTime":425.1,"endTime":426.61,"body":"The online medical resource"},{"speaker":"Welcome to episode 51","startTime":426.61,"endTime":428.59,"body":"that delivers the latest trusted content"},{"speaker":"Welcome to episode 51","startTime":428.59,"endTime":430.44,"body":"from the best minds in medicine."},{"speaker":"Welcome to episode 51","startTime":430.44,"endTime":433.043,"body":"Go to accessmedicine.com to learn more."}]}