Haemoptysis Flashcards
Mx of haemoptysis
Initial Mx:
Secure ABC
Positioning: bleeding site
ICU admission
Correct coagulopathy
Intubate with large ETT (size 8 & above)
Antifibrinolytic: Tranexamic acid
Bronchoscopy:
- Diagnostic
- Therapeutic:
a) temponade
b) cold saline lavage (4deg)
c) adrenaline 1:100 000
d) Insert Watanabe spigot
e) Insert Fogarty balloon catheter
f) ablative methods: electrocautery, APC, laser
Imaging:
If stable or unable to visualise bleeding site on bronch –> CTA
Others:
BAE
Surgery
Definition of life-threatening haemoptysis
1) volume: >100mls/24h
2) causes resp distress suggestive of airway obstruction or abnormal gas exchange
3) causes haemodynamic instability
Causes of haemoptysis
Common causes:
Bronchiectasis
Malignancy
Infection: TB, mycetoma
Others:
Airway disease: bronchitis, foreign body, bronchvasc fistula
Pulmonary vasculature: PE
Parenchymal: lung abscess, necrotizing pneumonia
Rheumatic: anti-GBM (Goodpasteur), vasculitis
Bleeding disorder: DIC, trauma, anticoag
Genetic disorder of collagen (Ehlers-Danlos)
Endometriosis (catamenial haemoptysis)
EVALI
Pseudohaemop (hemetemesis aspirated)
Risks of bronchial artery embolisation (BAE)
Neuro:
Spinal cord injury
Stroke
Transient cortical blindness
Transverse myelitis
GIT:
Oesophageal necrosis
Ischaemic colitis
Dysphagia
Resp:
Bronchial ischaemia
Esophagobronchial fistula
Cardiac:
Transient chest pain
