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Rosens > 20. Hemoptysis > Flashcards

20. Hemoptysis Flashcards

1
Q

hemoptysis defn

A

expectoration of blood from resp tract below vocal cords

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2
Q

massive hemoptysis defn

A

> 100ml or 1/2 cup blood loss in any 24h period or bleeding rate >/100ml/hour which may result in HD instability, shock or impaired gas exchange and
mortality rate of 80%

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3
Q

How many ml of blood volume is in the tracheopulmonary tree?

A

150

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4
Q

Highest short term mortality factors in a hemoptysis pt

A

alcoholism
active cancer
aspergillosis
pulmonary artery involvement
multifocal pulmonary infiltrates
need for mechanical ventilation at time of admission

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5
Q

DDX of hemoptysis

A

tb
bronchiectasis
lung abscesses
cancer
cf
avm
pneumonia
anticoag use
postprocedural complications

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6
Q

Specific causes of hemoptysis in peds that may be different than adults

A

infection
chd
cf
bleed from preexisting trach

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7
Q

Minor hemoptysis - where does this typically originate from?

A

tracheobronchial capillaries disrupted by vigorous coughing, minor bronchial infections

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8
Q

Massive hemoptysis - where does this come from?

A

bronchial or pulmonary arteries

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9
Q

Why do bronchial arteries cause a big problem as compared to pulmonary?

A

small caliber but high pressure

pulmonary - large vol of blood at lower pressure, less likely than bronchial to be culprit

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10
Q

How does bronchiectasis cause hemoptysis?

A

tissue distruction and remoeling can result in bleeding

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11
Q

Diffuse alveolar hemorrhage causes

A

gpa vasculitis
sle
goodpasture

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12
Q

Name 5 causes of hemoptysis - airway disease

A

Bronchitis (acute or chronic) Bronchiectasis
Neoplasm (primary and metastatic)
Trauma
Foreign body

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13
Q

Name 4 causes of hemoptysis - parenchymal disease

A

Tuberculosis (TB) Pneumonia, lung abscess Fungal infection Neoplasm

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14
Q

Name 4 causes of hemoptysis - vascular disease

A

Pulmonary embolism
Arteriovenous malformation
Aortic aneurysm
Pulmonary hypertension
Vasculitis (Wegener’s granulomatosis, systemic lupus erythematosus
[SLE], Goodpasture syndrome)

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15
Q

Name 4 causes of hemoptysis - hematologic disease

A

Coagulopathy (cirrhosis or warfarin therapy) Disseminated intravascular coagulation (DIC) Platelet dysfunction
Thrombocytopenia

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16
Q

Name 3 causes of hemoptysis - cardiac disease

A

Congenital heart disease (especially in children) Valvular heart disease
Endocarditis

17
Q

Name 4 causes of hemoptysis - miscellaneous

A

cocaine
postprocedural injiury
tracheal arterial fistula
sle

18
Q

PE for massive hemoptysis

A

vitals
abc
ensure not coming from gi/mouth/pharynx

assess for vasuclitis/skin changes

19
Q

Key hx questions for hemoptysis

A

hx of disease
amount/rate/appearance
coming from?
cancer sx
etoh, fungal infection hx
tb/travel hx

20
Q

Key labs for pt with hemoptysis

A

cbc
cr
urea
urea:cr ratio
coag test
t+screen _–> crossmatch

cxr poor, likely ct vs unknown cta

21
Q

when is cta first line for hemoptysis?

A

bronchial a hemorrhage suspected
angio assiste embolization tx to be performed
cause of hemoptysis unknown (ie malignancy)

22
Q

Name 5 critical diagnoses in patients presenting with hemoptysis:

A

Disseminated intravascular coagulopathy (DIC) Tracheo-innominate artery fistula (TIF) Aortobronchial fistula
Iatrogenic (postprocedural) hemoptysis Pulmonary embolism

23
Q

Name 5 emergent diagnoses in patients presenting with hemoptysis:

A

Trauma
Bronchiectasis
Pneumonia
Abscess/fungal infection Oral anticoagulant overdose Endocarditis

24
Q

If patient with hemoptysis presents with hx of tracheostomy new within -4 weeks, concern for ?

A

tracheoinnominate a fistula

25
Q

If ct chest is not diagnostic, what other test can you consider?

A

bronchoscopy

26
Q

Basic position for hemoptysis patient if hypoxic or HD unstable?

A

bleeding lung down
IV, IVF/blood,ffp, cardiac minor, pulse ox, intubation

concern for bronchial a hemorrhage? –> call cardiothoracic surgery, pulmonary/IR consult

27
Q

TIF suspected - what can emerg do?

A

overinflate trach balloon to try to tamponade

if fails, remove trach and oral intubate pt or place and apply pressure

28
Q

what size ett?

A

8 or larger

29
Q

How to perform a R mainstem intubation

A

advance tube in neutral pos
use 90 deg rotation techn in direction of desired placement and adv until resistance is met

30
Q

if life threatening hemoptysis or cannot intubate on first try, who to call?

A

anesthesia for double lumen ETT

31
Q

Complications of double lumen tubes

A

unil and bilat ptx
pneumomediastinum
carinal rupture
lobar collapse
tube malposition

32
Q

What is the most common cause of trace hemoptysis (blood-tinged sputum)?
a. Bronchiectasis
b. Bronchitis
c. Cancer
d. Congestive heart failure e. Pulmonaryembolism

A

b

33
Q

Disruption of which of the following vessels is responsible for the
vast majority of cases of massive hemoptysis? a. Aorta
b. Bronchial arteries
c. Pulmonary arteries
d. Pulmonary veins
e. Tracheobronchial capillaries

A

b

34
Q

A 50-year-old man presents after an episode of hemoptysis. He describes coughing up several large clots of dark blood. During his evaluation, he coughs and expectorates approximately 5 mL of clotted blood. The patient’s vital signs are normal, and no abnor- malities are noted on physical examination. His chest radiograph is normal. Which of the following is the most appropriate next step in the management of this patient?
a. Admission to an observation unit
b. Consultation for bronchoscopy
c. Consultation for percutaneous embolization
d. Discharge home with follow-up in 24 hours
e. Obtain chest high-resolution computed tomography (HRCT)
scan

A

e

35
Q

Which of the following statements regarding the evaluation of
hemoptysis is true?
a. Chest x-ray localizes the site of bleeding in nearly 90% of cases of
patients with large volume hemoptysis.
b. Conventional angiography is the preferred diagnostic test to
detect both bronchial and nonbronchial arterial causes of mas-
sive hemoptysis.
c. High-resolution CT, even with recent advances in technology,
remains diagnostically inferior to angiography.
d. Patients with fever, cough, and blood-tinged sputum should
receive a chest x-ray even if the vital signs are normal.

A

b

36
Q

A 58-year-old man with a single lung transplant presents to the
emergency department (ED) with what appears to be large-volume hemoptysis. He was just discharged from the endoscopy suite, where he had a number of surveillance biopsies performed. He looks pale and diaphoretic with an initial oxygen saturation of 71%. After placement of an intravenous line and supplemental oxygen, the next most appropriate step is:
a. Bloodtransfusion
b. High-resolution computed tomography scan of the chest c. Intubation
d. Thoracic surgery consultation

A

c

Rosens (59 decks)

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