hospitalized immediately. Interim therapy is treat- ment  aimed  at  preventing  further  attacks.  The offending  allergens  should  be  identified  and emotional  disturbances  eliminated,  if  possible. Drugs of choice in the interim therapy of asthma are the adrenal corticosteroids and corticotropin. Methylprednisone and IV hydrocortisone are the drugs normally used. A change in environmental conditions is indicated to prevent incapacitating or  further  complications. Fibrinous  Pleurisy This  condition  is  the  result  of  deposits  of fibrinous  exudate  on  the  pleural  surface.  It  is usually  secondary  to  pulmonary  disease. SYMPTOMS—There   is   chest   pain   that   is accentuated upon inspiration and minimal when the breath is held. The patient often lies on the affected  side  and  respirations  are  decreased  in motion  and  may  be  marked  with  a  “grunt.  ”  A pleural  friction  rub  is  often  present. TREATMENT—The  treatment  of  the  pleu- ritic pain is the only measure aimed at combating the fibrinous pleurisy. Other treatment is aimed at  the  underlying  cause.  Giving  analgesics  and strapping the chest to restrict movement is effec- tive in treating the pain. Pulmonary Abscess This is a localized area of necrosis in the lung that  may  be  putrid  or  nonputrid.  Bronchial obstruction  with  subsequent  infection  distal  to  the block may be caused by aspirated vomitus, blood, pus,  or  mucus.  It  may  also  follow  penetrating wounds  of  the  chest.  Putrid  abscesses  are usually single and caused by anaerobic bacteria. The right lung, especially the lower lobes, is most frequently  affected.  Nonputrid  abscesses  are usually hematogenous in origin and are usually multiple. SYMPTOMS—They  include  malaise,  ano- rexia,  cough,  sweating,  chills,  and  fever.  The cough  is  at  first  nonproductive  and  later  yields a  foul,  fetid  sputum  that  is  suggestive  of  an abscess. TREATMENT—General  measures  consist  of bed rest, postural drainage in the position of best drainage, and broad-spectrum antibiotic therapy. The patient may require evacuation for surgical resection, which is the treatment of choice when the risk is reasonable. Spontaneous Pneumothorax This  condition  results  from  air  entering  the pleural  space,  causing  a  partial  to  complete collapse  of  the  underlying  lung.  It  sometimes follows exertion or violent coughing. Occasionally a  valvelike  effect  is  produced  with  progressive  air leakage  upon  inspiration  and  failure  of  air  exit upon  expiration  (tension  pneumothorax). SYMPTOMS—Chest  pain  is  referred  to  the shoulder and arm of the affected side. The pain is   aggravated   by   inspiration   and   physical activity. Breath and voice sounds are diminished on  the  affected  side;  in  large  pneumothorax,  there is  a  mediastinal  shift  to  the  opposite  side. Percussion  produces  hyperresonance. TREATMENT—If the degree of lung collapse is small, air leakage slight, and little discomfort produced, the lung may reexpand spontaneously. If  the  degree  of  collapse  is  greater,  the  leakage of  air  more  pronounced,  and  the  patient’s discomfort great, insert a large-bore, short bevel needle  into  the  anterior  portion  of  the  affected area. Insert it just into the pleural space to avoid trauma  to  the  underlying  lung.  After  tension  is relieved,  make  a  one-way  valve  from  the  finger of a rubber glove, slit at the end, and tied to the hub  of  the  needle.  As  soon  as  possible,  insert  a Foley catheter into the pleural space and attach to  a  water  trap  (underwater  seal)  or  a  suction pump.  Provide  suction  until  the  lung  has  been reexpanded for 24 hours. Treat severe pain with subcutaneous  morphine.  Treat  for  shock. Traumatic Pneumothorax A   sucking   chest   wound   results   from   a penetrating  injury  to  the  chest  wall  and  is  a surgical  emergency.  The  wound  must  be  made airtight  by  any  available  means,  as  this  might convert the injury to a tension pneumothorax. If the  patient  becomes  increasingly  dyspneic,  remove the  dressing  to  allow  release  of  internal  pressure, then  reseal.  Treat  for  shock.  Surgical  intervention should  be  accomplished  as  soon  as  possible. Pulmonary  Embolism This  condition  results  from  a  clot  lodging  in a  pulmonary  vessel.  The  major  causes  are  chronic cardiac disease, phlebitic or thrombosed veins of the lower extremities, postoperative complication (second  or  third  week  usually),  and  traumatic fractures  (fat  embolism). 2-8