Hemoptysis Flashcards
Pulmonary vs bronchial circulation
Pulmonary: comes to the lungs to get oxygenated
Bronchial: blood supply of the airways
What blood supply is usually responsible for hemoptysis
Bronchial
Most common cause of hempotysis
Inflammation of the tracheobronchial mucosa
3 main causes of massive hemoptysis
TB
Bronchiectasis
Carcinoma
4 steps in general management of hemoptysis
Obtain history
Physical exam
Lab investigations
Management and intervention
Most important question to ask when taking history
How much blood?
What is the best way to diagnose
Combined bronchoscopy and CT
Rigid bronchoscopy
Secures the airway
Large port, greater suction
Limitation: OR/anesthesia, expertise needed
Flexible bronchoscopy
Ease of use, availability
Greater visualization of peripheral airways
Limitations: small port, decreased suction, decreased visualization
When should you do bronchoscopy?
Early and when they are actively bleeding
So that you can find the bleed and do something about it
Why do you use CT and bronch?
CT provides road map for bronchoscopist and diagnostic information
Bronch allows for tissue sampling and direct intervention
CT should precede bronch, but not appropriate in massive or unstable hemoptysis
Should you use a double lumen ET tube for massive hemoptysis?
No
Small individual lumens hinder bronch
Unable to effectively aspirate secretions/blood
Difficult to place and secure
Endobronchial tamponade
Direct tamponade effect
Leave balloon inflated for 24 hours and then deflate for observation
After no observed bleeding leave in situ deflated for another 24 hours
3 topical therapies
Cold saline irrigation Vasoconstrictive agent (epi) Topical coagulants (fibrinogen, thrombin)
2 physical ways to stop the bleeding
External beam radiation (but takes a few days)
Argon plasma coagulation
Argon plasma coagulation
Burn the tissue so it stops bleeding
Argon gas ignited by electric spark
Benefits: good hemostasis, can treat lesions lateral to or around corner from tip of catheter, safe use near metallic stents
Limits: delayed tissue effects, may need debridement 48hrs later
Risk: airway fire, air embolism
Bronchial artery embolization
Inject dye into arteries, take X-rays to visualize bleed, inject particles to stop the bleeding
Mainstay of treatment now
How much blood in massive hemoptysis?
400mL in 24 hours
What size ET tube should you use to intubate?
8.0
