Pocket Medicine

PULMONARYQ

HEMOPTYSIS

Definition and pathophysiology

•  Expectoration of blood or blood-streaked sputum

•  Massive hemoptysis: ~>600 mL/24–48 h; gas exchange more important than blood loss

•  Massive hemoptysis usually from tortuous or invaded bronchial arteries

Diagnostic workup

•  Localize bleeding site

Rule out GI or ENT source by exam, history; may require endoscopy

Pulmonary source: determine whether unilateral or bilateral, localized or diffuse, parenchymal or airway by CXR or chest CT, bronchoscopy if necessary

•  PT, PTT, CBC to rule out coagulopathy

•  Sputum culture/stain for bacteria, fungi and AFB; cytology to r/o malignancy

•  ANCA, anti-GBM, urinalysis to ✓ for vasculitis or pulmonary-renal syndrome

Treatment

•  Mechanism of death is asphyxiation not exsanguination; maintain gas exchange, reverse coagulation and treat underlying condition; cough supp. may ↑ risk of asphyxiation

•  Massive hemoptysis: put bleeding side dependent; selectively intubate nl lung if needed Angiography: Dx & Rx (vascular occlusion balloons or selective embol of bronchial artRigid bronchoscopy:allows more interventional options (electrocautery, laser) than flex. Surgical resection