Haemoptysis

Question 1

Management of massive haemoptysis:

Answer 1

Usually bronchogenic carcinoma

PPE
Nebulised TXA!! 1g
Call Anos and Resp.
CXR (if side unknown)

Head-up induction
LARGE dual suction
Large ETT (8 if poss, to allow bronch later)
- Rotate tube 90deg towards good lung (bevel)
- If L side bleeding, deliberate R main tube.
- If R side bleeding: NEED HELP.
—> Anos for Dual Lumen, Resp for selective placement via bronch etc.

Ultimately:
Bronch, intervention radiology, or thoracotomy

+usual haemostatic resus

Question 2

Differential for haemoptysis:

Answer 2

NOT ACTUALLY HAEMOPTYSIS
- Epistaxis
- Haematemesis

• EXTRAPULMONARY*
  CCF
  PE
  Dissection
  Coagulopathy
  Aspirated blood

PULMONARY
Infection - most common
- Pneumonia
- Bronchitis
- TB
- Lung abscess
Iatrogenic (30%)
PE
Trauma
AVM
Bronchiectasis, CF

Question 3

What non-imaging test can differentiate haemoptysis from haematemesis:

Answer 3

pH!

Haematemesis = acidic
Haemoptysis = alkaline

Question 4

Approach to stable patient with low volume haemoptysis:

Answer 4

Evaluate for likely cause: infective, neoplastic, anticoag etc.

FBC
Coags
Sputum MCS
CXR

Most can be discharged:
- +/- PO antis
- Follow up sputum result with GP
- Repeat CXR / CT/ nasoendoscopy/ bronchoscopy PRN.

Question 5

Definition of “massive haemoptysis*

Answer 5

>50ml per cough
150ml over 1hr

Ultimately, if you’re alarmed… massive.