Hemoptysis resident survival guide: Difference between revisions
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{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}} | {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; height: | {{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> | '''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> | * Postural [[pulse]] increment of > 30 beats/min <br> | ||
*Supine tachycardia (>100 beats/min) <br> | * Supine [[tachycardia]] (>100 beats/min) <br> | ||
*Supine hypotension </div>}} | * Supine hypotension <br> | ||
❑ Symptoms of [[hypovolemia]]: | |||
* [[Dizz]] <br> | |||
* [[Faint]] | |||
* [[Nausea]] | |||
* Very [[thirsty]] </div>}} | |||
{{familytree | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | |}} | {{familytree | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | |B01=<div style="float: left; text-align: left; height: 10em; width: 20em; padding:1em;"> ❑ Monitor patient in the intensive care unit <br> | {{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> | ❑ Secure [[airway]] permeability to avoid aspiration <br> | ||
❑ Place patient in lateral decubit towards site of bleeding (if only one lung is bleeding) </div> }} | ❑ Place patient in lateral decubit towards site of bleeding (if only one lung is bleeding) </div> }} | ||
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{{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 | | | D01 | | | | | | | | | | | | | | | | D02 | | | | | | | | | | |D01=<div style="float: left; text-align: left; height: 15em; width: 22em; padding:1em;"> ❑ Right away transfuse O- positive blood type. <br> | ||
❑ 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> | ❑ 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 | ❑ Make a [[thoracic surgery]] consult </div> | D02= [[CT]] }} {{familytree | | | |!| | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | | }} | ||
{{familytree | | | E01 |-|-|-|-|-|-|-|-|-|-|-| E02 | | | | | | E03 | | | | | | | | | | |E01= Bronchoscopy | E02= Diagnose not found | E03= Diagnose found}} | {{familytree | | | E01 |-|-|-|-|-|-|-|-|-|-|-| E02 | | | | | | E03 | | | | | | | | | | |E01= [[Bronchoscopy]] | E02= Diagnose not found | E03= Diagnose found}} | ||
{{familytree | |,|-|^|-|.| | | | | | | | | | | | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | | | | |}} | {{familytree | |,|-|^|-|.| | | | | | | | | | | | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | | | | |}} | ||
{{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 | 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 | |!| | | |!| | | | | | | | | | | | | |!| | | |!| | | |!| | | |!| | | | | | | | |}} | ||
{{familytree | G01 |-| G02 | | | | | | | | | | | | G03 | | G04 | | G05 | | G06 | | | | | | | |G01= Endobronchial taponade | G02= | {{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 | | | | | | | | | | | |H01= Bleeding localized | H02= Bleeding not localized | H03= Treat underlying disease | H04= Give appropriate antibiotics}} | {{familytree | | | H01 | | H02 | | | | | | | | | | H03 | | | | | | H04 | | | | | | | | | | | |H01= Bleeding localized | H02= Bleeding not localized | H03= Treat underlying disease | H04= Give appropriate antibiotics}} |
Revision as of 18:28, 29 January 2014
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
- 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
- Coagulopathy
Management
Characterise the symptoms [3] ❑ Coughing up blood | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Asses volume stauts ❑ General condition ❑ Mucosa Examine the patient ❑ Exclude hemorrhagic sites from nasopharynx and gastrointestinal track ❑ Skin (paleness) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Order lab ❑ Coagulation profile ❑ Blood typing and cross match | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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. [4]
Hemoptysis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mild hemoptysis ❑ <30 cc in 24 hours [5] | Moderate hemoptysis ❑ 30-200 cc in 24 hours [6] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Chest X-ray (CXR) | Chest X-ray and CT | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Diagnose found | Diagnose unknown | Diagnose found | Diagnose unknown | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treat underlying disease | Treat underlying disease | Bronchoscopy to find diagnosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
yes | No | Diagnose found | Diagnose unknown | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT or bronchoscopy to find diagnosis | Close monitoring | Treat underlying disease | {{{ Go4 }}} | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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. [8]
Massive hemoptysis ❑ 200-600cc or more in 48 hours [9] AND/OR
❑ Symptoms of hypovolemia: | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Monitor patient in the intensive care unit ❑ Secure airway permeability to avoid aspiration | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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.[11] [12] | 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 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
- ↑ name="pmid20058006">Chun JY, Morgan R, Belli AM (2010). "Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization". Cardiovasc Intervent Radiol. 33 (2): 240–50. doi:10.1007/s00270-009-9788-z. PMID 20058006.
- ↑ name="pmid10834728">Jean-Baptiste E (2000). "Clinical assessment and management of massive hemoptysis". Crit Care Med. 28 (5): 1642–7. PMID 10834728.
- ↑ 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.