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
- 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 radiography | Chest radiography 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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.