Hemoptysis resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Definition

Hemoptysis is the expectoration of blood from the respiratory system.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Hemoptysis may be a life-threatening condition depending on the severity of bleeding and must be treated as such irrespective of the causes.

Common Causes

• Pulmonary disease
  • Tuberculosis
  • Aspergilloma
  • Lung malignancy
    • Bronchial carcinoma, adenoma
    • Metastatic lung cancer
  • Chronic obstructive airway disease
  • Lung abscess
  • Cystic fibrosis
  • Sarcoidosis
  • Vasculitis
    • Wegener's granulomatosis
    • Behcet's disease
• Cardiovascular disease
  • Pulmonary artery arteriovenous malformation
  • Pulmonary embolism
  • pulmonary hypertension
  • Bronchial artery aneurysm
  • Thoracic aortic aneurysm
  • Aortobronchial fistula
• Others
  • Coagulopathy
    • Von Willebrand disease
    • Haemophilia
    • Trombocytopenia
  • Iatrogenic
    • Anticoagulation
  • Trauma

Management

Characterise the symptoms ❑ Coughing up blood ❑ Chest pain ❑ Tachypnea ❑ Dyspnea

Examine the patient Normal 0 21 false false false ES-TRAD JA X-NONE <ref > name="pmid10834728">Jean-Baptiste E (2000). "Clinical assessment and management of massive hemoptysis". Crit Care Med. 28 (5): 1642–7. PMID 10834728. </ref ❑ Inspection of nasopharynx and oropharynx to exclude hemorrhagic sites from Nasopharynx or gastrointestinal track ❑ Vital signs and oxygen saturation ❑ Respiratory rate ❑ Accessory respiratory muscles use ❑ Examine head and neck

❑ UGI bleed ❑ NP bleed

Order lab ❑ Complete blood count ❑ Arterial blood gas ❑ Coagulation profile ❑ Electrolites ❑ Blood typing and cross match ❑ Liver and renal function test

Stable patient

Unstable patient

Chest radiography

Mild hemoptysis

Moderate hemoptysis

Massive hemotysis ❑ Dysnea ❑ >600 cc of blood in 24 hours ❑ >150 cc of blood per hr Sings and symptoms of hypovolemia

❑ Secure airway permeability O negative blood type transfusion

Treat underlying disease

CT

Bronchoscopy

Diagnose found

Diagnose not found

Location of bleeding found

Location of bleeding not found

Treat underlying disease

Bronchoscopy

Endobronchial tamponade

Arteriography

Find location of bleeding

CT

Bronchial artery embolization

Treat the cause

Treat the cause

References

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