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 ❑ Fever Obtein detalled history ❑ Recent travel H/O ❑ Recent drug H/O ❑ Family H/O ❑ Systemic illness H/O

Asses volume stauts ❑ General condition ❑ Heart rate ❑ Blood pressure ❑ Respiratory rate ❑ Mucosa ❑ Pulmonary reserve Examine the patient ❑ Exclude hemorrhagic sites from nasopharynx and gastrointestinal track ❑ Skin (paleness) ❑ Respiratory system (use accessory respiratory muscles, murmur)

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 <30 cc in 24Hr

Moderate hemoptysis 30-200 cc in 24Hr

Massive hemotysis 200- 600cc or more in 48Hr or/and 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

Do's

• Investigate profusely the patients medical history for possible etiology.
• Intubate patient with massive hemoptysis to protect airway.
• Determine volume and rate of blood.
• All patients need to have oxygen to maintain oxyhemoglobin saturation.
• If the bleeding is located in one lung, the patient with massive hemoptysis must be placed on lateral deceit toward side of bleeding.
• Treat massive hemoptysis in a ICU.

Dont's

• Chest CT shouldn't

References

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