رجل عمره ٧٠ سنة عنده انصباب جنبي كبير في اليمين بسبب فشل القلب. أثناء بزل الصدر سُحب ١٤٠٠ مل، وبدأ المريض يسعل بشدة ويشتكي ضيق صدر وضيق نفس متزايد، والتشبع نزل من ٩٥٪ إلى ٨٩٪. ما التصرف الصحيح؟

A 70-year-old man has a large right pleural effusion from heart failure. During thoracentesis 1,400 mL has been removed when he starts coughing violently with chest tightness and increasing breathlessness; SpO2 falls from 95% to 89%. What is the correct action?

1. Give water to drink to settle the cough and continue
2. Continue until all the fluid is out
3. Stop draining, inform the physician, monitor breathing
4. Lay him flat and continue draining

Answer: C) Stop draining, inform the physician, monitor breathing. Removing large volumes quickly (often over 1–1.5 L) can cause re-expansion pulmonary oedema. Severe coughing and tightness are warning signs, so drainage stops. A post-procedure X-ray excludes pneumothorax.