Hemoptysis: Difference between revisions

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==Workup==
==Workup==
 
# Icon
 
# CBC
0) Icon
# Chem 7
 
# Coags
1) CBC
# T&S/T&C
 
# UA (autoimune)
2) Chem 7
# ECG (pulm HTN/PE)
 
# CXR (30% will be nl)
3) Coags
# Consider D-Dimer/Spiral CT
 
# IVF/blood/correct coagulop as nec
4) T&S/T&C
 
5) UA (autoimune)
 
6) ECG (pulm HTN/PE)
 
7) CXR (30% will be nl)
 
8) Consider D-Dimer/Spiral CT
 
9) IVF/blood/correct coagulop as nec
 


==DDx==
==DDx==
 
# Airway
 
## '''Bronchitis''' (acute/chronic)
I. Airway
## Bronchietctasis
 
## '''Neoplasm''' (primary/met)
    A. Bronchitis (acute/chronic)
## Trauma
 
## Foreign body
    B. Bronchietctasis
# Parenchymal Dz
 
## Infectious
    C. Neoplasm (primary/met)
### '''TB'''
 
### '''PNA'''
    D. Trauma
### Fungal
 
### Abcess
    E. Foreign body
## Autoimmune
 
### Goodpasture's
II. Parenchymal Dz
### SLE
 
### Wegener's
    A. Infectious
### Pulmonary Hemosiderosis
 
# Vascular
          1. TB
## PE (3-20%)
 
## AV malformation
          2. PNA
## Pulm HTN
 
## Aortic dissection
          3. Fungal
# Hematologic Dz
 
## Coagulopathy
          4. Abcess
## DIC
 
## Platelet dysfx
    B. Autoimmune
## Thrombocytopenia
 
# Cardiac
          1. Goodpasture's
## Mitral stenosis
 
## Tricuspid endocarditis
          2. SLE
# Misc
 
## Crack cocaine
          3. Wegener's
## Iatrogenic
 
## Tracheal-arterial fistula
          4. Pulmonary Hemosiderosis
 
III. Vascular
 
    A. PE (3-20%)
 
    B. AV malformation
 
    C. Pulm HTN
 
    D. Aortic dissection
 
IV. Hematologic Dz
 
    A. Coagulopathy
 
    B. DIC
 
    C. Platelet dysfx
 
    D. Thrombocytopenia
 
V. Cardiac
 
    A. Mitral stenosis
 
    B. Tricuspid endocarditis
 
VI. Misc
 
    A. Crack cocaine
 
    B. Iatrogenic
 
    C. Tracheal-arterial fistula
 


Bold: Most common in US
Bold: Most common in US
Line 103: Line 53:
MASSIVE = A single expectoration of ≥ 50cc OR >600cc/24h
MASSIVE = A single expectoration of ≥ 50cc OR >600cc/24h


*angle head down with affected lung low
#angle head down with affected lung low
 
#consider angio embolization
*consider angio embolization
#intubate with >8.0 (for bronch)
 
*intubate with >8.0 (for bronch)


==Disposition==
==Disposition==
ADMISSION
ADMISSION
 
# Massive
1) Massive
# Minor + high risk of massive bleed
 
2) Minor + high risk of massive bleed
 


==Source==
==Source==
3/19/06 DONALDSON (adapted from Rosen)
3/19/06 DONALDSON (adapted from Rosen)


[[Category:Pulm]]
[[Category:Pulm]]

Revision as of 06:13, 6 June 2011

Workup

  1. Icon
  2. CBC
  3. Chem 7
  4. Coags
  5. T&S/T&C
  6. UA (autoimune)
  7. ECG (pulm HTN/PE)
  8. CXR (30% will be nl)
  9. Consider D-Dimer/Spiral CT
  10. IVF/blood/correct coagulop as nec

DDx

  1. Airway
    1. Bronchitis (acute/chronic)
    2. Bronchietctasis
    3. Neoplasm (primary/met)
    4. Trauma
    5. Foreign body
  2. Parenchymal Dz
    1. Infectious
      1. TB
      2. PNA
      3. Fungal
      4. Abcess
    2. Autoimmune
      1. Goodpasture's
      2. SLE
      3. Wegener's
      4. Pulmonary Hemosiderosis
  3. Vascular
    1. PE (3-20%)
    2. AV malformation
    3. Pulm HTN
    4. Aortic dissection
  4. Hematologic Dz
    1. Coagulopathy
    2. DIC
    3. Platelet dysfx
    4. Thrombocytopenia
  5. Cardiac
    1. Mitral stenosis
    2. Tricuspid endocarditis
  6. Misc
    1. Crack cocaine
    2. Iatrogenic
    3. Tracheal-arterial fistula

Bold: Most common in US

Treatment

MASSIVE = A single expectoration of ≥ 50cc OR >600cc/24h

  1. angle head down with affected lung low
  2. consider angio embolization
  3. intubate with >8.0 (for bronch)

Disposition

ADMISSION

  1. Massive
  2. Minor + high risk of massive bleed

Source

3/19/06 DONALDSON (adapted from Rosen)

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