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

Management of Mild to Moderate Hemoptysis

The algorithm is based on the American Family Physician Journal of hemoptysis: Diagnosis and Management 1.

Hemoptysis

Mild hemoptysis ❑ <30 cc in 24 hours

Moderate hemoptysis ❑ 30-200 cc in 24 hours

Chest X-ray (CXR)

Chest X-ray and CT

Diagnose found

Diagnose unknown

Diagnose found

Diagnose unknown

Treat underlying disease

Risk of malignancy ❑ Smoking ❑ Occupational exposure ❑ Family history ❑ Previous cancer treatment

Treat underlying disease

Bronchoscopy to find diagnosis

yes

No

Diagnose found

Diagnose unknown

CT or bronchoscopy to find diagnosis

Close monitoring

Treat underlying disease

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Diagnose found

Diagnose unknown

If hemoptysis persist consult with pneumonologist

Treat underlying Disease

Close monitoring

Management of Massive Hemoptysis

The algorithm is based on the Society of Critical Care Medicine Journal of clinical assessment and management of massive hemoptysis.

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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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