Hemoptysis resident survival guide: Difference between revisions

Latest revision as of 15:35, 27 February 2018

For hemoptysis chapter, click here.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Teresa Stahl, M.D. [2]

Overview

Hemoptysis is the medical term for expectorating blood from the trachea, larynx, bronchi or lungs. It can be confused with hematemesis. There are many causes for hemoptysis including bronchiectasis, respiratory infections, iatrogenic. Massive hemoptysis can be a life-threatening condition and should be treated immediately.

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

Management

Characterize the symptoms^[1]

❑ Coughing up blood
❑ Chest pain
❑ Tachypnea
❑ Dyspnea
❑ Fever
Obtein detailed 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 tract

❑ Skin (pallor)

❑ Respiratory system (use accessory respiratory muscles, murmur)

Order lab

❑ Complete blood count

❑ Arterial blood gas

❑ Coagulation profile

❑ Electrolytes

❑ Blood typing and crossmatch

❑ Liver and renal function test

Hemoptysis

Upper gastrointestinal bleeding

Nasopharynx bleeding

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 ^[2]

Hemoptysis

Mild hemoptysis
❑ <30 cc in 24 hours ^[3]

Moderate hemoptysis
❑ 30-200 cc in 24 hours ^[4]

Chest X-ray (CXR)

Chest X-ray and CT

Diagnose found

Diagnose unknown

Diagnose found

Diagnose unknown

Treat underlying disease

Risk of malignancy^[5]

❑ 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

Close monitoring

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. ^[6]

Massive hemoptysis
❑ 200-600cc or more in 48 hours ^[7]

AND/OR
❑ Signs of hypovolemia: ^[8]

Postural pulse increment of > 30 beats/min
Supine tachycardia (>100 beats/min)
Supine hypotension

❑ Symptoms of hypovolemia:

❑ Monitor patient in the intensive care unit

❑ Secure airway permeability to avoid aspiration

❑ Place patient in lateral decubit towards site of bleeding (if only one lung is bleeding)

Unstable patient

Stable patient

❑ Right away transfuse O- positive blood type.

❑ If the patient has a life-threatening hemoptysis and/or a hypovolemic shock and/or hypoxemia; intubate with a 8-mm or larger endotracheal tube to allow subsequent bronchoscopy.^[9] ^[10]

❑ Make a thoracic surgery consult

CT

Bronchoscopy

Diagnose not found

Diagnose found

Bleeding localised

Bleeding not localized

Intersticial,
reticular pattern

Infiltrate

Cavity

Nodular,
cystic lesion

Endobronchial taponade

Pulmonary angiography

Search for interstitial lung diseases

Give appropriate antibiotics

Search for tuberculosis, aspergilloma, lung abscess

Give appropriate antibiotics

Bleeding localized

Bleeding not localized

Treat underlying disease

Give appropriate antibiotics

Bronchial artery embolization (BAE)

Conservative therapy

Treat underlying disease

Do's

Investigate profusely the patient's medical history for possible diagnosis.
Intubate patient with massive hemoptysis to protect airway. ^[11]
Determine volume and rate of blood. ^[12]
Supply all patients with oxygen to maintain oxyhemoglobin saturation.^[13]
Place the patient with massive hemoptysis in lateral decubit towards side of bleeding (if bleeding is located in one lung). ^[14]
Treat massive hemoptysis in a ICU. ^[15]
Place patient in isolation when tuberculosis is suspected, until the septum is analysed. ^[16]

Dont's

Don't perform chest CT before bronchoscopy or bronchial artery embolization in unstable patients. ^[17]
Don't use invasive therapeutic in patients with anticoagulant therapy, blood dyscrasia or goodpasture syndrome.^[18]
Don't operate in patients with lung carcinoma invading the trachea, mediastinum, heart, great vessels, and parietal pleura; in patients with terminal diseases or advanced pulmonary disease. ^[19]

References

↑ Parrillo, Joseph E.; Dellinger, R. Phillip. (2014). Critical care medicine : principles of diagnosis and management in the adul. Philadelphia, PA: Elsevier/Saunders. ISBN 978-0-323-08929-6.
↑ name="pmid16225028">Bidwell JL, Pachner RW (2005). "Hemoptysis: diagnosis and management". Am Fam Physician. 72 (7): 1253–60. PMID 16225028.
↑ name="pmid12243312">Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B (2002). "Hemoptysis: a retrospective analysis of 108 cases". Respir Med. 96 (9): 677–80. PMID 12243312.
↑ name="pmid12243312">Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B (2002). "Hemoptysis: a retrospective analysis of 108 cases". Respir Med. 96 (9): 677–80. PMID 12243312.
↑ Parkin DM, Boyd L, Walker LC (2011). "16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010". Br J Cancer. 105 Suppl 2: S77–81. doi:10.1038/bjc.2011.489. PMC 3252065. PMID 22158327.
↑ name="pmid10834728">Jean-Baptiste E (2000). "Clinical assessment and management of massive hemoptysis". Crit Care Med. 28 (5): 1642–7. PMID 10834728.
↑ name="pmid12243312">Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B (2002). "Hemoptysis: a retrospective analysis of 108 cases". Respir Med. 96 (9): 677–80. PMID 12243312.
↑ name="pmid15726060">Sinert R, Spektor M (2005). "Evidence-based emergency medicine/rational clinical examination abstract. Clinical assessment of hypovolemia". Ann Emerg Med. 45 (3): 327–9. doi:10.1016/j.annemergmed.2004.09.021. PMID 15726060.
↑ Parrillo, Joseph E.; Dellinger, R. Phillip. (2014). Critical care medicine : principles of diagnosis and management in the adul. Philadelphia, PA: Elsevier/Saunders. ISBN 978-0-323-08929-6.
↑ Nilsson, Kent R.; Piccini, Jonathan. (2006). The Osler medical handbook / the Osler Medical Service, The Johns Hopkins Hospital ; editors, Kent R. Nilsson, Jr., Jonathan Picci. Philadelphia: Saunders/Elsevier. ISBN 978-0-323-03748-8.
↑ Parrillo, Joseph E.; Dellinger, R. Phillip. (2014). Critical care medicine : principles of diagnosis and management in the adul. Philadelphia, PA: Elsevier/Saunders. ISBN 978-0-323-08929-6.
↑ name="pmid16225028">Bidwell JL, Pachner RW (2005). "Hemoptysis: diagnosis and management". Am Fam Physician. 72 (7): 1253–60. PMID 16225028.
↑ Parrillo, Joseph E.; Dellinger, R. Phillip. (2014). Critical care medicine : principles of diagnosis and management in the adul. Philadelphia, PA: Elsevier/Saunders. ISBN 978-0-323-08929-6.
↑ Parrillo, Joseph E.; Dellinger, R. Phillip. (2014). Critical care medicine : principles of diagnosis and management in the adul. Philadelphia, PA: Elsevier/Saunders. ISBN 978-0-323-08929-6.
↑ Nilsson, Kent R.; Piccini, Jonathan. (2006). The Osler medical handbook / the Osler Medical Service, The Johns Hopkins Hospital ; editors, Kent R. Nilsson, Jr., Jonathan Picci. Philadelphia: Saunders/Elsevier. ISBN 978-0-323-03748-8.
↑ Nilsson, Kent R.; Piccini, Jonathan. (2006). The Osler medical handbook / the Osler Medical Service, The Johns Hopkins Hospital ; editors, Kent R. Nilsson, Jr., Jonathan Picci. Philadelphia: Saunders/Elsevier. ISBN 978-0-323-03748-8.
↑ Parrillo, Joseph E.; Dellinger, R. Phillip. (2014). Critical care medicine : principles of diagnosis and management in the adul. Philadelphia, PA: Elsevier/Saunders. ISBN 978-0-323-08929-6.
↑ name="pmid10834728">Jean-Baptiste E (2000). "Clinical assessment and management of massive hemoptysis". Crit Care Med. 28 (5): 1642–7. PMID 10834728.
↑ name="pmid10834728">Jean-Baptiste E (2000). "Clinical assessment and management of massive hemoptysis". Crit Care Med. 28 (5): 1642–7. PMID 10834728.

Template:WikiDoc Sources

[1] Parrillo, Joseph E.; Dellinger, R. Phillip. (2014). Critical care medicine : principles of diagnosis and management in the adul. Philadelphia, PA: Elsevier/Saunders. ISBN 978-0-323-08929-6.

[2] ="pmid16225028">Bidwell JL, Pachner RW (2005). "Hemoptysis: diagnosis and management". Am Fam Physician. 72 (7): 1253–60. PMID 16225028.

[3] ="pmid12243312">Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B (2002). "Hemoptysis: a retrospective analysis of 108 cases". Respir Med. 96 (9): 677–80. PMID 12243312.

[4] ="pmid12243312">Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B (2002). "Hemoptysis: a retrospective analysis of 108 cases". Respir Med. 96 (9): 677–80. PMID 12243312.

[pmid22158327-5] Parkin DM, Boyd L, Walker LC (2011). "16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010". Br J Cancer. 105 Suppl 2: S77–81. doi:10.1038/bjc.2011.489. PMC 3252065. PMID 22158327.

[6] ="pmid10834728">Jean-Baptiste E (2000). "Clinical assessment and management of massive hemoptysis". Crit Care Med. 28 (5): 1642–7. PMID 10834728.

[7] ="pmid12243312">Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B (2002). "Hemoptysis: a retrospective analysis of 108 cases". Respir Med. 96 (9): 677–80. PMID 12243312.

[8] ="pmid15726060">Sinert R, Spektor M (2005). "Evidence-based emergency medicine/rational clinical examination abstract. Clinical assessment of hypovolemia". Ann Emerg Med. 45 (3): 327–9. doi:10.1016/j.annemergmed.2004.09.021. PMID 15726060.

[9] Parrillo, Joseph E.; Dellinger, R. Phillip. (2014). Critical care medicine : principles of diagnosis and management in the adul. Philadelphia, PA: Elsevier/Saunders. ISBN 978-0-323-08929-6.

[10] Nilsson, Kent R.; Piccini, Jonathan. (2006). The Osler medical handbook / the Osler Medical Service, The Johns Hopkins Hospital ; editors, Kent R. Nilsson, Jr., Jonathan Picci. Philadelphia: Saunders/Elsevier. ISBN 978-0-323-03748-8.

[11] Parrillo, Joseph E.; Dellinger, R. Phillip. (2014). Critical care medicine : principles of diagnosis and management in the adul. Philadelphia, PA: Elsevier/Saunders. ISBN 978-0-323-08929-6.

[12] ="pmid16225028">Bidwell JL, Pachner RW (2005). "Hemoptysis: diagnosis and management". Am Fam Physician. 72 (7): 1253–60. PMID 16225028.

[13] Parrillo, Joseph E.; Dellinger, R. Phillip. (2014). Critical care medicine : principles of diagnosis and management in the adul. Philadelphia, PA: Elsevier/Saunders. ISBN 978-0-323-08929-6.

[14] Parrillo, Joseph E.; Dellinger, R. Phillip. (2014). Critical care medicine : principles of diagnosis and management in the adul. Philadelphia, PA: Elsevier/Saunders. ISBN 978-0-323-08929-6.

[15] Nilsson, Kent R.; Piccini, Jonathan. (2006). The Osler medical handbook / the Osler Medical Service, The Johns Hopkins Hospital ; editors, Kent R. Nilsson, Jr., Jonathan Picci. Philadelphia: Saunders/Elsevier. ISBN 978-0-323-03748-8.

[16] Nilsson, Kent R.; Piccini, Jonathan. (2006). The Osler medical handbook / the Osler Medical Service, The Johns Hopkins Hospital ; editors, Kent R. Nilsson, Jr., Jonathan Picci. Philadelphia: Saunders/Elsevier. ISBN 978-0-323-03748-8.

[17] Parrillo, Joseph E.; Dellinger, R. Phillip. (2014). Critical care medicine : principles of diagnosis and management in the adul. Philadelphia, PA: Elsevier/Saunders. ISBN 978-0-323-08929-6.

[18] ="pmid10834728">Jean-Baptiste E (2000). "Clinical assessment and management of massive hemoptysis". Crit Care Med. 28 (5): 1642–7. PMID 10834728.

[19] ="pmid10834728">Jean-Baptiste E (2000). "Clinical assessment and management of massive hemoptysis". Crit Care Med. 28 (5): 1642–7. PMID 10834728.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{CMG}}
-==Definition==
+'''For hemoptysis chapter, click [[Hemoptysis|here]].'''
-Hemoptysis is the expectoration of blood from the respiratory system.
+{{CMG}}; {{AE}}{{TSA}}
+==Overview==
+[[Hemoptysis]] is the medical term for expectorating [[blood]] from the [[trachea]], [[larynx]], [[bronchi]] or [[lungs]]. It can be confused with [[hematemesis]]. There are many causes for hemoptysis including [[bronchiectasis]], [[Respiratory tract infection|respiratory infections]], [[Iatrogenesis|iatrogenic]]. Massive hemoptysis can be a life-threatening condition and should be treated immediately.
 ==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.
+* 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
+* [[Anticoagulant|Anticoagulants]]
-**Tuberculosis
+* [[Bronchiectasis]]
-**Aspergilloma
+* [[Coagulopathy]]
-**Lung malignancy
+** [[Von Willebrand's disease]]
-***Bronchial carcinoma, adenoma
+** [[Hemophilia A|Hemophilia]]
-***Metastatic lung cancer
+** [[Thrombocytopenia]]
-**Chronic obstructive airway disease
+* [[Cystic fibrosis]]
-**Lung abscess
+* [[Iatrogenic]]
-**Cystic fibrosis <ref> name="pmid20058006">{{cite journal| author=Chun JY, Morgan R, Belli AM| title=Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization. | journal=Cardiovasc Intervent Radiol | year= 2010 | volume= 33 | issue= 2 | pages= 240-50 | pmid=20058006 | doi=10.1007/s00270-009-9788-z | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20058006  }} </ref>
+* [[Infection]]
-**Sarcoidosis
+** [[Tuberculosis]]
-**Vasculitis <ref> name="pmid10834728">{{cite journal| author=Jean-Baptiste E| title=Clinical assessment and management of massive hemoptysis. | journal=Crit Care Med | year= 2000 | volume= 28 | issue= 5 | pages= 1642-7 | pmid=10834728 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10834728  }} </ref>
+** [[Aspergillosis|Aspergilloma]]
-***Wegener's granulomatosis
+** [[Lung abscess]]
-***Behcet's disease
+* [[Lung cancer]]
-*Cardiovascular disease
+* [[Pulmonary embolism]]
-**Pulmonary artery arteriovenous malformation
+* [[Pulmonary hypertension]]
-**Pulmonary embolism
+* [[Sarcoidosis]]
-**pulmonary hypertension
+* [[Trauma]]
-**Bronchial artery aneurysm
+* [[Vasculitis]]: [[Wegener's granulomatosis]], [[Behcet's disease]]
-**Thoracic aortic aneurysm
-**Aortobronchial fistula
-*Others
-**Coagulopathy
-***Von Willebrand disease
-***Haemophilia
-***Trombocytopenia
-**Iatrogenic
-***Anticoagulation
-**Trauma
 ==Management==
 {{Family tree/start}}
-{{familytree  | | | | | | | | A01 | | | | | |A01=<div style="float: left; text-align: left; height: 20em; width: 30em; padding:1em;">  <u>'''Characterise the symptoms'''</u>  <ref>{{Cite book  | last1 = Parrillo | first1 = Joseph E. | last2 = Dellinger | first2 = R. Phillip. | title = Critical care medicine : principles of diagnosis and management in the adul | date = 2014 | publisher = Elsevier/Saunders | location = Philadelphia, PA | isbn = 978-0-323-08929-6 | pages =  }}</ref> <br>
+{{familytree  | | | | | | | | A01 | | | | | |A01=<div style="float: left; text-align: left; height: 20em; width: 30em; padding:1em;">  <u>'''Characterize the symptoms'''</u><ref>{{Cite book  | last1 = Parrillo | first1 = Joseph E. | last2 = Dellinger | first2 = R. Phillip. | title = Critical care medicine : principles of diagnosis and management in the adul | date = 2014 | publisher = Elsevier/Saunders | location = Philadelphia, PA | isbn = 978-0-323-08929-6 | pages =  }}</ref><br>
-❑ Coughing up blood <br>
+❑ Coughing up [[blood]] <br>
 ❑ [[Chest pain]] <br>
 ❑ [[Tachypnea]] <br>
 ❑ [[Dyspnea]]  <br>
 ❑ [[Fever]] <br>
-<u>'''Obtein detalled history'''</u> <br>
+<u>'''Obtein detailed history'''</u> <br>
 ❑ Recent travel H/O <br>
 ❑ Recent drug H/O <br>
@@ Line 55: / Line 50: @@
 {{familytree  | | | | | | | | A02 | | | | | | A02=<div style="float: left; text-align: left; height: 25em; width: 30em; padding:1em;">  <u>'''Asses volume stauts'''</u><br>
 ❑ General condition <br>
-❑ Heart rate <br>
+❑ [[Heart rate]] <br>
 ❑ [[Blood pressure]] <br>
 ❑ [[Respiratory rate]] <br>
+❑ [[Mucosa]] <br>
-❑ Mucosa <br>
+❑ [[Pulmonary]] reserve <br>
-❑ [[Pulmonary reserve]] <br>
 <u>'''Examine the patient'''</u> <br>
-❑ Exclude hemorrhagic sites from nasopharynx and gastrointestinal track <br>
+❑ Exclude hemorrhagic sites from [[nasopharynx]] and [[gastrointestinal tract]]<br>
-❑ Skin (paleness) <br>
+❑ [[Skin]] ([[pallor]]) <br>
-❑ [[Respiratory system]] (use accessory respiratory muscles, murmur) </div> }}
+❑ [[Respiratory system]] (use accessory [[respiratory]] muscles, [[murmur]])</div> }}
 {{familytree  | | | | | | | | |!| | | | | | | }}
 {{familytree  | | | | | | | | D01 | | | | | |D01=<div style="float: left; text-align: left; height: 15em; width: 30em; padding:1em;"> <u>'''Order lab'''</u> <br>
@@ Line 79: / Line 70: @@
 ❑ [[Arterial blood gas]] <br>
-❑ Coagulation profile <br>
+❑ [[Coagulation]] profile <br>
 ❑ [[Electrolytes]] <br>
-❑ Blood typing and cross match <br>
+❑ [[Blood typing]] and crossmatch <br>
-❑ Liver and renal function test </div>}}
+❑ [[Liver]] and [[renal]] function test </div>}}
 {{familytree  | | | |,|-|-|-|-|+|-|-|-|-|.| | }}
-{{familytree  | | | E01 | | | E02 | | | E03 | E01= Hemoptysis | E02= [[Upper gastrointestinal bleeding]] | E03= Nasopharynx bleed }}
+{{familytree  | | | E01 | | | E02 | | | E03 | E01= Hemoptysis | E02= [[Upper gastrointestinal bleeding]] | E03= [[Nasopharynx]] [[bleeding]] }}
 {{familytree  | | | | | | | | |!| | | | |!| | }}
 {{familytree  | | | | | | | | F01 | | | F02 | F01= Follow [[Upper gastrointestinal bleeding resident survival guide]]| F02= Refer to otolaryngologist }}
@@ Line 94: / Line 85: @@
 ==Management of Mild to Moderate Hemoptysis==
-The algorithm is based on the American Family Physician Journal of hemoptysis: Diagnosis and Management 1.     <ref > name="pmid16225028">{{cite journal| author=Bidwell JL, Pachner RW| title=Hemoptysis: diagnosis and management. | journal=Am Fam Physician | year= 2005 | volume= 72 | issue= 7 | pages= 1253-60 | pmid=16225028 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16225028  }} </ref>
+The algorithm is based on the American Family Physician Journal of hemoptysis: Diagnosis and Management <ref>name="pmid16225028">{{cite journal| author=Bidwell JL, Pachner RW| title=Hemoptysis: diagnosis and management. | journal=Am Fam Physician | year= 2005 | volume= 72 | issue= 7 | pages= 1253-60 | pmid=16225028 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16225028  }} </ref>
 {{Family tree/start}}
@@ Line 105: / Line 96: @@
 {{familytree  | D01 | | | | | | D02 | | | | | D03 | | | | | | D04 | | | | | | |D01= Diagnose found | D02= Diagnose unknown | D03= Diagnose found | D04= Diagnose unknown}}
 {{familytree  | |!| | | | | | | |!| | | | | | |!| | | | | | | |!| | | | | | | |}}
-{{familytree  | E01 | | | | | | E02 | | | | | E03 | | | | | | E04 | | | | | | |E01= Treat underlying disease | E02= <div style="float: left; text-align: left; height: 10em; width: 12em; padding:1em;"> '''Risk of malignancy'''<br>
+{{familytree  | E01 | | | | | | E02 | | | | | E03 | | | | | | E04 | | | | | | |E01= Treat underlying disease | E02= <div style="float: left; text-align: left; height: 10em; width: 12em; padding:1em;"> '''Risk of malignancy'''<ref name="pmid22158327">{{cite journal| author=Parkin DM, Boyd L, Walker LC| title=16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. | journal=Br J Cancer | year= 2011 | volume= 105 Suppl 2 | issue=  | pages= S77-81 | pmid=22158327 | doi=10.1038/bjc.2011.489 | pmc=PMC3252065 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22158327  }} </ref><br>
 ❑ [[Smoking]] <br>
@@ Line 114: / Line 105: @@
 ❑ Previous cancer treatment </div> | E03= Treat underlying disease | E04= Bronchoscopy to find diagnosis}}
 {{familytree  | | | | | |,|-|-|-|^|-|-|-|.| | | | | | |,|-|-|-|^|-|-|-|.| | | |}}
-{{familytree  | | | | | F01 | | | | | | F02 | | | | | F03 | | | | | | F04 | | | F01= yes | F02= No | F03= Diagnose found | F04= Diagnose unknown}}
+{{familytree  | | | | | F01 | | | | | | F02 | | | | | F03 | | | | | | F04 | | | F01= Yes | F02= No | F03= Diagnose found | F04= Diagnose unknown}}
 {{familytree  | | | | | |!| | | | | | | |!| | | | | | |!| | | | | | | |!| | | |}}
-{{familytree  | | | | | G01 | | | | | | G02 | | | | | G03 | | | | | | Go4 | | | G01= CT or bronchoscopy to find diagnosis| G02= Close monitoring | G03= Treat underlying disease | G04= Close monitoring}}
+{{familytree  | | | | | G01 | | | | | | G02 | | | | | G03 | | | | | | G04 | | | G01= [[CT]] or [[bronchoscopy]] to find diagnosis| G02= Close monitoring | G03= Treat underlying disease | G04= Close monitoring}}
 {{familytree  | |,|-|-|-|^|-|-|-|.| | | |!| | | | | | | | | | | | | | | | | | |}}
 {{familytree  | H01 | | | | | | H02 | | H03 | | | | | | | | | | | | | | | | | | H01= Diagnose found | H02= Diagnose unknown | H03= If hemoptysis persist consult with pneumonologist}}
@@ Line 125: / Line 116: @@
 ==Management of Massive Hemoptysis==
-The algorithm is based on the Society of Critical Care Medicine Journal of clinical assessment and management of massive hemoptysis. <ref > name="pmid10834728">{{cite journal| author=Jean-Baptiste E| title=Clinical assessment and management of massive hemoptysis. | journal=Crit Care Med | year= 2000 | volume= 28 | issue= 5 | pages= 1642-7 | pmid=10834728 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10834728  }} </ref>
+The algorithm is based on the Society of Critical Care Medicine Journal of clinical assessment and management of massive hemoptysis. <ref>name="pmid10834728">{{cite journal| author=Jean-Baptiste E| title=Clinical assessment and management of massive hemoptysis. | journal=Crit Care Med | year= 2000 | volume= 28 | issue= 5 | pages= 1642-7 | pmid=10834728 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10834728  }} </ref>
 {{Family tree/start}}
 {{familytree  | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
-{{familytree  | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |}}
+{{familytree  | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; height: 23em; width: 20em; padding:1em;"> <u>'''Massive hemoptysis'''</u> <br> ❑ 200-600cc or more in 48 hours <ref> name="pmid12243312">{{cite journal| author=Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B| title=Hemoptysis: a retrospective analysis of 108 cases. | journal=Respir Med | year= 2002 | volume= 96 | issue= 9 | pages= 677-80 | pmid=12243312 | doi= | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12243312  }} </ref> <br>
+'''AND/OR'''<br>
+❑ Signs of [[hypovolemia]]: <ref> name="pmid15726060">{{cite journal| author=Sinert R, Spektor M| title=Evidence-based emergency medicine/rational clinical examination abstract. Clinical assessment of hypovolemia. | journal=Ann Emerg Med | year= 2005 | volume= 45 | issue= 3 | pages= 327-9 | pmid=15726060 | doi=10.1016/j.annemergmed.2004.09.021 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15726060  }} </ref> <br>
+* Postural [[pulse]] increment of > 30 beats/min <br>
+* Supine [[tachycardia]] (>100 beats/min) <br>
+* Supine hypotension <br>
+❑ Symptoms of [[hypovolemia]]:
+* [[Dizz]] <br>
+* [[Faint]]
+* [[Nausea]]
+* Very [[thirsty]] </div>}}
 {{familytree  | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | |}}
-{{familytree  | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | |}}
+{{familytree  | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | |B01=<div style="float: left; text-align: left; height: 10em; width: 20em; padding:1em;"> ❑ Monitor patient in the [[intensive care unit]] <br>
+❑ Secure [[airway]] permeability to avoid aspiration <br>
+❑ Place patient in lateral decubit towards site of bleeding (if only one lung is bleeding) </div> }}
 {{familytree  | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| | | | | | | | | | | |}}
-{{familytree  | | | C01 | | | | | | | | | | | | | | | | C02 | | | | | | | | | | |}}
+{{familytree  | | | C01 | | | | | | | | | | | | | | | | C02 | | | | | | | | | | |C01= Unstable patient | C02= Stable patient}}
 {{familytree  | | | |!| | | | | | | | | | | | | | | | | |!| | | | | | | | | | | |}}
-{{familytree  | | | D01 | | | | | | | | | | | | | | | | D02 | | | | | | | | | | |}}
+{{familytree  | | | D01 | | | | | | | | | | | | | | | | D02 | | | | | | | | | | |D01=<div style="float: left; text-align: left; height: 15em; width: 22em; padding:1em;"> ❑ Right away transfuse O- positive blood type. <br>
-{{familytree  | | | |!| | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | | }}
-{{familytree  | | | E01 |-|-|-|-|-|-|-|-|-|-|-| E02 | | | | | | E03 | | | | | | | | | | |}}
+❑ If the patient has a life-threatening hemoptysis and/or a [[hypovolemic shock]] and/or [[hypoxemia]]; intubate with a 8-mm or larger endotracheal tube to allow subsequent bronchoscopy.<ref>{{Cite book  | last1 = Parrillo | first1 = Joseph E. | last2 = Dellinger | first2 = R. Phillip. | title = Critical care medicine : principles of diagnosis and management in the adul | date = 2014 | publisher = Elsevier/Saunders | location = Philadelphia, PA | isbn = 978-0-323-08929-6 | pages =  }}</ref> <ref>{{Cite book  | last1 = Nilsson | first1 = Kent R. | last2 = Piccini | first2 = Jonathan. | last3 =  | first3 =  | title = The Osler medical handbook / the Osler Medical Service, The Johns Hopkins Hospital ; editors, Kent R. Nilsson, Jr., Jonathan Picci | date = 2006 | publisher = Saunders/Elsevier | location = Philadelphia | isbn = 978-0-323-03748-8 | pages =  }}</ref> <br>
+❑ Make a [[thoracic surgery]] consult </div> | D02= [[CT]] }}                                                                                                                                                 {{familytree  | | | |!| | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | | }}
+{{familytree  | | | E01 |-|-|-|-|-|-|-|-|-|-|-| E02 | | | | | | E03 | | | | | | | | | | |E01= [[Bronchoscopy]] | E02= Diagnose not found | E03= Diagnose found}}
 {{familytree  | |,|-|^|-|.| | | | | | | | | | | | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | | | | |}}
-{{familytree  | F01 | | F02 | | | | | | | | | | | | F03 | | F04 | | F05 | | F06 | | | | |}}
+{{familytree  | F01 | | F02 | | | | | | | | | | | | F03 | | F04 | | F05 | | F06 | | | | |F01= Bleeding localised | F02= Bleeding not localized | F03= Intersticial,<br> reticular pattern | F04= Infiltrate | F05= Cavity | F06= Nodular,<br> cystic lesion }}
 {{familytree  | |!| | | |!| | | | | | | | | | | | | |!| | | |!| | | |!| | | |!| | | | | | | | |}}
-{{familytree  | G01 |-| G02 | | | | | | | | | | | | G03 | | G04 | | G05 | | G06 | | | | | | | |}}
+{{familytree  | G01 |-| G02 | | | | | | | | | | | | G03 | | G04 | | G05 | | G06 | | | | | | | |G01= Endobronchial taponade | G02= [[Pulmonary angiography]] | G03= Search for [[interstitial lung diseases]] |G04= Give appropriate antibiotics | G05= Search for [[tuberculosis]], [[aspergilloma]], [[lung abscess]] | G06= Give appropriate antibiotics }}
-{{familytree  | | | |,|-|^|-|.| | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | |}}
+{{familytree  | | | |,|-|^|-|.| | | | | | | | | | | |!| | | | | | | |!| | | | | | | | | | | | |}}
-{{familytree  | | | H01 | | H02 | | | | | | | | | | H03 | | | | | | H04 | | | | | | | | | | | |}}
+{{familytree  | | | H01 | | H02 | | | | | | | | | | H03 | | | | | | H04 | | | | | | | | | | | |H01= Bleeding localized | H02= Bleeding not localized | H03= Treat underlying disease | H04= Give appropriate antibiotics}}
 {{familytree  | | | |!| | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
-{{familytree  | | | I01 | | I02 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
+{{familytree  | | | I01 | | I02 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |I01= Bronchial artery embolization (BAE) | I02= Conservative therapy }}
 {{familytree  | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
-{{familytree  | | | J01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
+{{familytree  | | | J01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |J01= Treat underlying disease}}
 {{Family tree/end}}
 ==Do's==
-*Investigate profusely the patients medical history for possible etiology.
+*Investigate profusely the patient's [[medical history]] for possible diagnosis.
-*Intubate patient with massive hemoptysis to protect airway.
+*Intubate patient with massive hemoptysis to protect airway. <ref>{{Cite book  | last1 = Parrillo | first1 = Joseph E. | last2 = Dellinger | first2 = R. Phillip. | title = Critical care medicine : principles of diagnosis and management in the adul | date = 2014 | publisher = Elsevier/Saunders | location = Philadelphia, PA | isbn = 978-0-323-08929-6 | pages =  }}</ref>
-*Determine volume and rate of blood.
+*Determine volume and rate of blood. <ref>name="pmid16225028">{{cite journal| author=Bidwell JL, Pachner RW| title=Hemoptysis: diagnosis and management. | journal=Am Fam Physician | year= 2005 | volume= 72 | issue= 7 | pages= 1253-60 | pmid=16225028 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16225028  }} </ref>
-*All patients need to have oxygen to maintain oxyhemoglobin saturation.
+*Supply all patients with oxygen to maintain [[oxyhemoglobin]] saturation.<ref>{{Cite book  | last1 = Parrillo | first1 = Joseph E. | last2 = Dellinger | first2 = R. Phillip. | title = Critical care medicine : principles of diagnosis and management in the adul | date = 2014 | publisher = Elsevier/Saunders | location = Philadelphia, PA | isbn = 978-0-323-08929-6 | pages =  }}</ref>
-*If the bleeding is located in one lung, the patient with massive hemoptysis must be placed on lateral deceit toward side of bleeding.
+*Place the patient with massive hemoptysis in lateral decubit towards side of bleeding (if bleeding is located in one lung). <ref>{{Cite book  | last1 = Parrillo | first1 = Joseph E. | last2 = Dellinger | first2 = R. Phillip. | title = Critical care medicine : principles of diagnosis and management in the adul | date = 2014 | publisher = Elsevier/Saunders | location = Philadelphia, PA | isbn = 978-0-323-08929-6 | pages =  }}</ref>
-*Treat massive hemoptysis in a ICU.
+*Treat massive hemoptysis in a [[ICU]]. <ref>{{Cite book  | last1 = Nilsson | first1 = Kent R. | last2 = Piccini | first2 = Jonathan. | last3 =  | first3 =  | title = The Osler medical handbook / the Osler Medical Service, The Johns Hopkins Hospital ; editors, Kent R. Nilsson, Jr., Jonathan Picci | date = 2006 | publisher = Saunders/Elsevier | location = Philadelphia | isbn = 978-0-323-03748-8 | pages =  }}</ref>
+* Place patient in isolation when [[tuberculosis]] is suspected, until the [[septum]] is analysed. <ref>{{Cite book  | last1 = Nilsson | first1 = Kent R. | last2 = Piccini | first2 = Jonathan. | last3 =  | first3 =  | title = The Osler medical handbook / the Osler Medical Service, The Johns Hopkins Hospital ; editors, Kent R. Nilsson, Jr., Jonathan Picci | date = 2006 | publisher = Saunders/Elsevier | location = Philadelphia | isbn = 978-0-323-03748-8 | pages =  }}</ref>
 ==Dont's==
-*Chest CT shouldn't
+* Don't perform chest CT before bronchoscopy or bronchial artery embolization in unstable patients. <ref>{{Cite book  | last1 = Parrillo | first1 = Joseph E. | last2 = Dellinger | first2 = R. Phillip. | title = Critical care medicine : principles of diagnosis and management in the adul | date = 2014 | publisher = Elsevier/Saunders | location = Philadelphia, PA | isbn = 978-0-323-08929-6 | pages =  }}</ref>
+* Don't use [[invasive therapeutic]] in patients with [[anticoagulant]] therapy, blood [[dyscrasia]] or [[goodpasture syndrome]].<ref>name="pmid10834728">{{cite journal| author=Jean-Baptiste E| title=Clinical assessment and management of massive hemoptysis. | journal=Crit Care Med | year= 2000 | volume= 28 | issue= 5 | pages= 1642-7 | pmid=10834728 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10834728  }} </ref>
+* Don't operate in patients with [[lung carcinoma]] invading the [[trachea]], [[mediastinum]], [[heart]], [[great vessels]], and [[parietal pleura]]; in patients with terminal diseases or advanced pulmonary disease. <ref>name="pmid10834728">{{cite journal| author=Jean-Baptiste E| title=Clinical assessment and management of massive hemoptysis. | journal=Crit Care Med | year= 2000 | volume= 28 | issue= 5 | pages= 1642-7 | pmid=10834728 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10834728  }} </ref>
 ==References==

Hemoptysis resident survival guide: Difference between revisions

Latest revision as of 15:35, 27 February 2018

Overview

Causes

Life Threatening Causes

Common Causes

Management

Management of Mild to Moderate Hemoptysis

Management of Massive Hemoptysis

Do's

Dont's

References

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