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
- Coagulopathy
Management
Characterise the symptoms ❑ Coughing up blood ❑ Chest pain ❑ Tachypnea ❑ Dyspnea | |||||||||||||||||||||||||||||||||||
Examine the patient ❑ Inspection of nasopharynx and oropharynx to exclude hemorrhagic sites from Nasopharynx or gastrointestinal track ❑ Vital signs and oxygen saturation ❑ Respiratory rate ❑ Accessory respiratory muscles use | |||||||||||||||||||||||||||||||||||
❑ UGI bleed ❑ NP bleed | |||||||||||||||||||||||||||||||||||
Order lab ❑ Complete blood count ❑ Arterial blood gas ❑ Coagulation profile ❑ Electrolites ❑ Blood typing and cross match | |||||||||||||||||||||||||||||||||||
Stable patient | Unstable patient | ||||||||||||||||||||||||||||||||||
Chest radiography | |||||||||||||||||||||||||||||||||||
Mild hemoptysis | Moderate hemoptysis | Massive hemotysis ❑ Dysnea ❑ >600 cc of blood in 24 hours ❑ >150 cc of blood per hr 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 | ||||||||||||||||||||||||||||||||||