Hemoptysis Flashcards
About massive hemoptysis (medical emergency)
1) Blood loss of ___ mL in 24 hours, or ___-__ mL expectorated at one time
2) Unquantified amount but with ____ or ___
1) 400, 100-150
2) hemodynamic instability or anemia requiring transfusion
true or false: amount of blood expectorated equals the amount of blood lost into airspaces
false!
most common cause of mortality from blood filling airways and airspaces
asphyxiation
Hemoptysis should be distinguished from ___
epistaxis
Identify if hemoptysis or hematemesis
- GI tract
- respiratory tract
- persistent cough
- acidic pH
- dark red or brown
- bright red
- foamy, runny
- mixed with food
- in clumps
- alkaline pH
- stomachache, abdominal discomfort
- nausea, retching before/after
- chest pain, warmth or gurgling over chest
- mixed with mucus
tem - GI tract mop - respiratory tract mop - persistent cough tem - acidic pH tem - dark red or brown mop - bright red mop - foamy, runny tem - mixed with food tem - in clumps mop - alkaline pH tem - stomachache, abdominal discomfort tem - nausea, retching before/after mop - chest pain, warmth or gurgling over chest mop - mixed with mucus
Which contribute to hemoptysis: bronchial arteries or pulmonary arteries?
bronchial arteries -In addition to being perfused at a higher pressure, they also supply blood to the airways and to lesions within the airways
First step in evaluating hemoptysis?
determine the amount, character and severity of bleeding
Detailed history for hemoptysis
1) Fever, chills, or antecedent cough may suggest ___
2) Presence of blood-streaking of mucopurulent or purulent sputum often suggests ___
3) Chronic production of sputum with a recent change in quantity or
appearance favors an ___
4) Putrid smell to the sputum: ___
5) Hemoptysis following the acute onset of pleuritic chest pain and sudden dyspnea: ____
6) A family history of hemoptysis or brain aneurysms may suggest ___
7) A history of smoking or unintentional weight loss makes ___ more likely
1) infection
2) bronchitis
3) acute exacerbation of chronic bronchitis
4) lung abscess
5) pulmonary embolism
6) hereditary hemorrhagic telangiectasia
7) malignancy
PE for hemoptysis
1) The presence of these conditions should raise concern
2) Clubbing can suggest underlying lung diseases such as (3)
3) what conditions suggest vascultides?
1) hypoxemia, tachypnea, tachycardia and respiratory distress
2) lung cancer, chronic lung anscess or cystic fibrosis
3) Signs of bleeding diathesis (e.g., skin or mucosal ecchymoses and petechiae) or telangectasias
Diagnostic study required for all hemoptysis patients
chest imaging
Diagnostic studies
In patients without risk factors for malignancy and with normal CXR, what is a reasonable strategy?
Treat for bronchitis and ensure close follow-up. Further diagnostic work up if bleeding persists
Additional diagnostic tests
Sputum for cytology/microbiology
Serologic tests for Wegener’s granulomatosis, SLE, or Goodpasture’s syndrome (helpful if +)
2D echo may detect endocarditis, mitral stenosis, congenital heart disease, or pulmonary HPN
Transesophageal echo aortic aneurysm
Identify if the evaluation is bronchoscopy or chest CT scan
1) highest yield for localizing bleeding site if performed during active bleeding
2) procedure of choice if suspect: bronchiectasis, lung abscess, peripheral mass lesions, including cancer, mycetomas, and AVM’S, ILDs
3) to visualize endobronchial lesions in patients with normal/non-localizing CXR
4) Disadvantage: temporary movement of an unstable patient away from ICU
1) (rigid/fibreoptic) bronchoscopy
2) chest CT scan
3) bronchoscopy
4) chest CT scan
Sources of hemoptysis (2)
Localized – e.g., pneumonia, lung abscess, PTB
Diffuse/ Systemic Process – e.g., coagulopathies, autoimmune diseases such
as Goodpasture’s syndrome
Most common etiology: ___
Common cause worldwide: ___
: infection of the medium-sized airways
PTB
