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 ❑ Electrolytes ❑ Blood typing and cross match ❑ Liver and renal function test

Hemoptysis

Upper gastrointestinal bleeding

Nasopharynx bleed

Follow Upper gastrointestinal bleeding resident survival guide

Refer to otolaryngologist

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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