Chapter 63: hemotysis Flashcards
Definition of massive hemoptysis
Ranges 100 mL per 24 hours to >1000 mL per 24 hours
Midpoint: 600 mL per 24 hours
Definition of “Minor” hemoptysis
- small volume
- no comorbid lung disease
- normal/stable oxygenation and ventilation
- normal vital signs
- no risk factor for continued bleeding
Artery that accounts for 99% of the blood flow to the lungs, low pressure and rarely cause of massive hemoptysis
Pulmonary arteries
Artery that accounts for only 1% of blood flow to the lungs, high pressure system, account for 90% of cases of hemoptysis
Bronchial Arteries
Most common causes of potentially massive hemoptysis
Parenchymal in Origin: TB, mycetoma, neoplasm, bronchiectasis
Leading cause of hemoptysis worldwide
Tuberculosis
Initial imaging modality in hemoptysis
Chest radiograph
How will you intubate a patient with massive hemoptysis
- a larger-diameter endotracheal tube to allow for bronchoscopy
- place the patient so the affected lung is in a dependent position to prevent spilling of blood into the unaffected side
- If bleeding is uncontrollable, you may preferentially intubate the main bronchus of the unaffected lung
Features of flexible, Fiberoptic bronchoscopy
- fully view of upper and peripheral lesions
- DOES NOT ALLOW SUCTIONING AND LOCAL TREATMENT
Features of RIGID BRONCHOSCOPY
- Requires gen anesth or deep sedation
- GREAT FOR SUCTIONING AND ALLOWS LOCAL TREATMENT (Passage of fogarty catheter, epi instillation, and ice water lavage)
- cannot fully view upper and peripheral lesions
initial and most effective treatment of massive and recurrent hemoptysis
Bronchial artery embolization
Risks of bronchial artery embolization
- Transverse myelitis (due to spinal cord ischemia)
- Pulmonary artery infarction (spread of embolic material)
