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haemoptysis

haemoptysis

Introduction

Is it really haemoptysis?

  • pseudohemoptysis
    • blood coming from the upper airways eg. posterior epistaxis, sinusitis,
  • haematemesis
    • pH < 7, blood is dark red or brown not bright red

aetiology

Mx of massive haemoptysis

  • haemoptysis > 200mL places these patients at high risk of asphyxiation from the haemoptysis and a high mortality, especially so if the cause is a neoplasm
  • iv cannula
  • take bloods for FBE, U&E, LFTs, coagulation profile and DIC screen, cross match,
  • oxygen to maintain SaO2
  • secure airway via intubation (consider size 8.0 ETT to allow suctioning and bronchoscopy)
    • may need to use selective intubation to only ventilate the non-bleeding lung
    • consider placing a double lumen endotracheal tube (permits ventilation of both lungs, while preventing aspiration from one lung to another)
  • CXR - generally picks up 80-90% of neoplastic causes
  • correct any coagulopathy
  • admit ICU
  • if bleeding site is known, place pt. in the lateral decubitus position with the affected lung in the dependent position
  • consider endobronchial tamponade with a Foley catheter (< 4 Fr)
  • consider CT chest if stable
  • urgent referral to thoracics for ?bronchoscopy
  • may need catheter-directed bronchial artery embolization (BAE) or even lobectomy

Mx of non-massive haemoptysis

haemoptysis.txt · Last modified: 2021/07/31 09:18 by wh