Hemoptysis

Revision as of 05:18, 28 September 2015 by Rossdonaldson1 (talk | contribs) (Differential Diagnosis)

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

Diagnosis=

  • 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
  • Labs
    • CBC
    • Coags
    • Sputum stain/cx
    • Chem (cr)
    • T&S/T&C
    • UA (autoimmune)
    • ECG (pulm HTN/PE)

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

  • 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

References