Haemoptysis Flashcards
What is massive haemoptysis?
It is coughing up of blood of between 100-600ml in 24 hours but anything above 250ml is worrisome
- also any amount of blood loss that causes haemodynamic instability and respiratory distress
- drop in HB, the need for blood transfusion, drop in SATS, drop in BP or tachycardia
What are the causes of haemoptysis?
- Bronchiectasis
- Tuberculosis
- Aspergilloma
- Bronchogenic carcinoma ( dyspnea, cough, blood stained sputum)
- pulmonary embolism(mitral stenosis)
What is the management of haemoptysis?
- ABC
- Make sure you secure the airway with intubation
- Stabilise the cardiovascular function with IV/blood transfusion
- Give cough suppressants( codeine, morphine)
- sometimes we give nebulisers
- X-ray onec the patient is stable
What are the 3 questions you should ask yourself if a patient presents with haemoptysis?
- Is it massive?
- What is the cause?
- What can I do?
Who are the high risk patients that we need to make sure we observe?
- patients with post TB structural lung disease especially those with aspergillomas in the lung cavities
- patients who have persistent haemoptysis despite therapy(>48 hours)
- patients with Rausmesens aneurysm
- pregnant ladies
- patients on anticoagulants like warfarin
What is the most common cause of massive haemoptsysis?
Post TB lung disease
What are the two circulations that often lead to bleeding in TB that leads to massive haemoptysis?
- Bronchial arterial circulation which is high pressure because it comes from systemic circulation
- Pulmonary arterial circulation which has much lower pressure (12-16 mmHg)
What is Rassmusen’s aneurysm?
A small percentage of patients may bleed from the pulmonary circulation,
and in the setting of ACTIVE TB, this may be from an aneurysmal dilatation
in the vessel wall caused by infection of the vessel
-it is often fatal
