S8C66 - Hemoptysis

Question 1

Hemoptysis: DDx

Answer 1

Infxs: bronchitis, PNA, abscess, TB, parasites
Cancer
CVS: PE, mitral stenosis, CHF, pulm HTN, angiodysplasia, AV malformation and fistula
Alveolar hemorrhage syndromes: behcet, goodpasture, wegener, SLE
Hematologic: uremia, AC therapy (ASA, plavix, warfarin)
Traumatic: FB, ruptured bronchus
Iatrogenic: bronchoscopy, bx
Inflammatory: bronchiectasis, CF
Misc: tularemia, plague, crack cocaine, endometriosis

Question 2

Mild/mod/Severe Hemoptysis

Answer 2

-Mild: 600cc in 24h

–not evidence based, no prediction on outcome

-other way to classify could be blood-streaked/speckled sputum VS gross hemoptysis with clotted blood VS massive hemoptysis interfering with ventilation/oxygenation

Question 3

Life-threatening hemoptysis: management

Answer 3

• pts usually die of asphyxia not exanguination
• intrubate with large diameter ETT (8mm for bronchoscopy) if resp failiure, poor gas exchange, hemodynamic instability

-if coagulopathy then give FFP, reverse any meds they may be on (vit K, octaplex) and consider TXS or factor VIIa

Question 4

Non-life threatening hemoptysis: management

Answer 4

• gross hemoptysis: admit, CT, get bronchoscopy, bleeding may worsen
• scant hemoptysis: CXR normal and low risk for cancer (