Hemoptysis: Difference between revisions
| Line 10: | Line 10: | ||
==Diagnosis== | ==Diagnosis== | ||
===Workup=== | |||
*Imaging | *Imaging | ||
**CXR | **CXR | ||
| Line 24: | Line 25: | ||
**UA (autoimmune) | **UA (autoimmune) | ||
**ECG (pulm HTN/PE) | **ECG (pulm HTN/PE) | ||
===Evaluation=== | |||
*Massive = A single expectoration of ≥ 50cc OR >600cc/24h | |||
==Treatment== | ==Treatment== | ||
Revision as of 05:22, 28 September 2015
Background
- Coughing of blood that originates from respiratory tract below level of larynx
- Death usually occurs from asphyxiation, not exanguination
- Easy to confuse w/ epistaxis or oropharynx bleeding
Clinical Features
Differential Diagnosis
Hemoptysis
- Infectious
- Neoplastic
- Lung cancer
- Metastatic cancer
- Cardiovascular
- Pulmonary embolism
- Congestive heart failure
- Pulmonary hypertension
- AV malformation
- Mitral stenosis
- Alveolar hemorrhage syndromes
- Hematologic
- Uremia
- Platelet dysfunction (ASA, clopidogrel)
- Anticoagulant therapy
- Traumatic
- Foreign body aspiration
- Ruptured bronchus
- Inflammatory
- Miscellaneous
- Cocaine inhalation (crack lung)
- Catamenial pneumothorax
- Goodpasture syndrome
- Cystic fibrosis
- Epistaxis
- Blood-laced mucus from the sinus or nose area
- Upper GI bleeding
Diagnosis
Workup
- Imaging
- CXR
- Nml in 30% (most of whom end up having bronchitis)
- Chest CT w/ IV contrast
- Indicated for gross hemoptysis or suspicious CXR
- Bronchoscopy
- CXR
- Labs
- CBC
- Coags
- Sputum stain/cx
- Chem (cr)
- T&S/T&C
- UA (autoimmune)
- ECG (pulm HTN/PE)
Evaluation
- Massive = A single expectoration of ≥ 50cc OR >600cc/24h
Treatment
- Pt Placement
- Placing pt w/ affected lung down may actually worsen V-Q mismatch
- Some advocate for prone positioning
- Intubation
- Use 8-0 tube to allow for subsequent bronchoscopy
- If possible can selectively intubate the unaffected bronchus to prevent aspiration
- After tube passes through cords rotate 90degrees left or right and advance
- Coagulopathy
- FFP
- Emergenct bronchoscopy or embolization for life-threatening hemorrhage
Massive
- Angle head down with affected lung low
- Consider angio embolization
- Intubate with >8.0 (for bronch)
Disposition
- Gross hemoptysis:
- Admit
- Young pt (<40yr) w/ scant hemoptysis, nl CXR, no smoking history:
- Discharge
- Risk factors for neoplasm (even if CXR nl) or suspicious CXR:
- Discuss w/ pulmonologist before d/c