Hemoptysis Flashcards
what is hemoptysis?
spitting of blood from the lungs or bronchi as a result of pulmonary or bronchial hemorrhage (a symptom, NOT a diagnosis)
what are the two main types?
non massive versus massive
what causes hemoptysis? describe pulmonary and bronchial pressure systems
MANY causes (infection, cancer, pulmonary venous HTN, idiopathic)
- Pulmonary system has low pressure and low volume bleeding (blood gas exchange)
- Bronchial system has systemic pressures and high volume bleeding (arterial pressure)
for men 65 years and older who have new onset hemoptysis, what is their percent chance of having lung cancer?
15-20%
what type of people are mostly likely to get hemoptysis?
patients on anticoagulant use
immunocompromised patients are more likely to get _______ than healthy patients
tumors, TB, Kaposi’s sarcoma
what patient presentation is a powerful sign of cancer?
cachexia (muscle wasting)
on a CXR done after having hemoptysis, what are some common signs of pulmonary issues on the CXR?
cardiomegaly (CHF, MV stenosis), lesions (abscess, TB, cancer), infiltrates (pneumo, pulm edema)
if a pt presents with hemoptysis and they have a positive sed rate test, what type of disease are you thinking of?
rheumatoid
what are common lab tests to run for a pt with hemoptysis?
WBC (lower & upper resp infections), hemoglobin/hematocrit (anemia), platelet count (thrombocytopenia), prothrombin time/INR (anticoagulated pts)
Treatment for non massive vs massive hemoptysis
1) . massive is more severe so want a more aggressive, quick approach (intensive care plus early consult with pulmonologist), airway management is vital
2) . non massive= find the cause, diagnose, and treat it, more likely treated on an outpatient basis, close monitoring and maybe outpatient pulm consult. Outpatient bronchoscopy or CT may be needed
what is the most common cause of nonmassive hemoptysis**
bronchitis
what are some interventions for massive hemoptysis?
bronchoscopy, endobronchial tamponade, double-lumen endotracheal intubation, bronchial artery embolization (85-98% success rate), surgery (poor success rate)
what is massive versus nonmassive hemoptysis (based on hadleys definition)?
non massive- small amount of blood mixed with sputum
massive- more blood coming from the bronchial arterial supply
what is a deciding factor in the management of massive hemoptysis after all initial ED protocol (O2, labs, CXR, pulm consult)?
vital signs
a) . poor vital signs - intubation and transfusion (more conservative tx)
b) . adequate vital signs- chest CT with contrast (find specific cause of it if patient is stable enough)
