Definition Coughing up of blood or bloody sputum Frightening event Patients Doctors Manifestation of underlying disease process Causes of hemoptysis Pulmonary embolism infarction Left ven ID: 941524
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Management of Hemoptysis Definition Coughing up of blood or bloody sputum. Frighteni
ng event: Patients & ± Doctors Manifestation of underlying disease process. Causes o
f hemoptysis Pulmonary embolism & infarction Left ventricular failure / MS Causes of
hemoptysis Alveolar hemorrhage syndromes Idiopathic Thrombocytopenia / Coagulopathy
Approach to management Severity of hemoptysis? Therapy of hemoptysis? Does th
e patient truly have hemoptysis? – Upper airways: Spurious hemoptysis Spurious h
emoptysis above vocal cords • Teeth / Gums / mouth Factitious hemoptysis • N
ose / Pharynx / larynx History: Feeling of blood pooling in the mouth The need to clea
r the throat Epistaxis Not preceded by cough Rhinoscopy / Laryngoscopy Does the
patient truly have hemoptysis? Chest or Cardiac disease Dyspepsia, Vomiting Retching,
Epigastric pain Bright red, alkaline with froth & sputum Coffee-ground, acidic + Food
particles of vomitus for few days after the Epigastric tenderness, Liver Does the pat
ient truly have hemoptysis? Lesions receive blood supply from Bronchial arteries and o
ther systemic arteries Communication between bronchial & pulmonary Erosion or Rupture
of Vessels Severity of hemoptysis? Respiratory reserve Volume of hemoptysis �200 m
l / day large Respiratory function & Gas exchange Massive hemoptysis: � 600 ml / 24
hour. Emergency intervention needed Presenting Clinical manifestation (s)? Feat
ure Asbestos exposure Bronchogenic carcinoma Risk factors for aspiration (alcohol,swal
lowing disorder, procedure Traumatic or Iatrogenic lung Medication & drug use Previous
ly diagnosed Pulmonary, Cardiac or Presenting Clinical manifestation (s)? Feature Sy
mptoms Hoarseness of voice Bronchogenic carcinoma Bronchiectasis Bronchitis MS/LVF Dys
pnea & Pleuritic chest Weight loss, Night sweats, Bronchogenic carcinoma Presenting C
linical manifestation (s)? Examination of Oropharynx & nasopharynx Presenting Clin
ical manifestation (s)? Feature Localized decrease in intensity of breath sounds, Bro
nchogenic carcinoma, Bronchial breath sounds Clubbing of fingers LVF Normal or non lo
calizing Diagnostic tests? Bronchogenic carcinoma, Wegner`s Bronchogenic carcino
ma, FB aspiration Hilar / Mediastinal Fungal infection, Sarcoidosis TB, fungal infecti
on, Mycetoma Lung abscess, Bronchogenic carcinoma Air space consolidation Pneumonia, A
lveolar hemorrhage, Diagnostic tests? Normal or non localizing C-XR After non diagno
stic bronchoscopyLocalizing C-XR Diagnostic tests? Fiberoptic bronchoscopy (FOB) wit
hin 24 hour of onset of Diagnostic tests? Fiberoptic bronchoscopy (FOB) Non massive
hemoptysis Instillation of diluted adrenaline. FOB 80% of malignancies Non Localizing
CXR + CT FOB 60% of malignancies • Interventional equipments: • Laser.
9; Cryotherapy. • Electrocautery. Before After Before Diagnostic tests? Urine
analysis & renal function Diagnostic tests? Sputum examination • Gross blood
infectious conditions • Acid fast bacilli • Culture • Cytology • P
H Diagnostic tests? Endovascular Embolization Bronchial artery & related Therapy of
hemoptysis? Specific cause of hemoptysis Identify bleeding site & protect uninvolved
lung Treat primary cause Therapy of hemoptysis? gram, ZN, Culture CT scan chest: Co
nventional ,HRCT, with pulmonary angiography Coagulation studies, ABG, CBC, ESR, Urine
analysis, renal function & Collagen profile Treatment is Directed to underlying cause
Therapy of hemoptysis? Endotracheal tube: risk of asphyxiation Cough suppressant: C
odeine sulphate 15 mg Treatment of Coagulopathy if present Therapy for hemoptysis? L
ung resection (emergency) Mortality 30% Elective surgery after stabilization Patient
with hemoptysis History & physical Establish true hemoptysis Exclude Hematemesis ENT
source CBC , Coagulation studies Severity of hemoptysis Severity of hemoptysis Mi
ld Intermittent bleeding Elective work up CT scan chest Establish etiology & treat
specific disease MassiveModerate Actively bleeding Emergency ICU admission Admit for
observation Conservative therapy CT scan chest Fiberoptic bronchoscopy Hemoptysis
stopped Hemoptysis continues Resection / Embolization �� Massive hemoptysis O
xygen supplementation / Assisted ventilation TTT of Coagulopathy if present Special c
atheters & tubes : ET, double lumen ET, Fogerty Wash, suction , iced saline, diluted
adrenaline Interventional procedure: laser,electro, Cryo CT scan chest Establish eti