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    HEMOPTYSIS

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    Varun B Renukappa
    Hemoptysis is defined as coughing up blood from the lungs or bronchial tubes. Mild hemoptysis involves less than 100 ml of blood per day, while massive hemoptysis involves more than 500 ml of blood per day or 150 ml per hour, with a mortality rate of 80% for massive cases. The most common source of bleeding is the bronchial artery, which originates from the aorta. Infections such as bronchitis are a major cause of hemoptysis. Initial steps in treatment involve identifying the bleeding side, positioning the patient, establishing an airway, and controlling the bleeding.

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    HEMOPTYSIS

    Uploaded by

    Varun B Renukappa
    79 views37 pages
    Hemoptysis is defined as coughing up blood from the lungs or bronchial tubes. Mild hemoptysis involves less than 100 ml of blood per day, while massive hemoptysis involves more than 500 ml of blood per day or 150 ml per hour, with a mortality rate of 80% for massive cases. The most common source of bleeding is the bronchial artery, which originates from the aorta. Infections such as bronchitis are a major cause of hemoptysis. Initial steps in treatment involve identifying the bleeding side, positioning the patient, establishing an airway, and controlling the bleeding.

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    Hemoptysis is defined as coughing up blood from the lungs or bronchial tubes. Mild hemoptysis involves less than 100 ml of blood per day, while massive hemoptysis involves more than 500 ml of blood per day or 150 ml per hour, with a mortality rate of 80% for massive cases. The most common source of bleeding is the bronchial artery, which originates from the aorta. Infections such as bronchitis are a major cause of hemoptysis. Initial steps in treatment involve identifying the bleeding side, positioning the patient, establishing an airway, and controlling the bleeding.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    79 views37 pages

    HEMOPTYSIS

    Uploaded by

    Varun B Renukappa
    Hemoptysis is defined as coughing up blood from the lungs or bronchial tubes. Mild hemoptysis involves less than 100 ml of blood per day, while massive hemoptysis involves more than 500 ml of blood per day or 150 ml per hour, with a mortality rate of 80% for massive cases. The most common source of bleeding is the bronchial artery, which originates from the aorta. Infections such as bronchitis are a major cause of hemoptysis. Initial steps in treatment involve identifying the bleeding side, positioning the patient, establishing an airway, and controlling the bleeding.

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    HEMOPTYSIS

    Hemoptysis is defined as the spitting of blood


    derived from the lungs or bronchial tubes as a
    result of pulmonary or bronchial hemorrhage.

    Hemo- Latin-Blood
    Ptysis- Greek- Spitting

    Stedman TL. Stedman’s Medical dictionary. 27th ed. Philidelphia: Lipincott Williams &
    Wilkins
    Mild- <100 ml/day
    Mod- 100-150 ml/day
    Severe- 150-200 ml/day
    Massive- >500ml/day; 150ml/hr; 100ml/day for
    more than 3 days.
    Non massive- <200 ml/day
    Massive- > 200ml/day. (1-5%)- Mortality-80%.

    American academy of family Physicians.


    • Source of bleeding:
    Bronchial artery- 90%
    Pulmonary artery
    Bronchial artery
    Blood Circulation in the lungs :
    2 Components
    Low pressure High pressure
    Pulmonary Circulation Bronchial Circulation
    SBP = 15-20 mmHg = systemic pressures
    DBP = 5-10 mmHg
    Bronchial arteries & collaterals
    Patients with normal PAP ( no originate from the aorta
    PAH) rarely bleed: only 5% of
    The source of bleeding in most
    massive hemoptysis
    cases

    • Inflammation  Erosion of the vessel wall

    • Increased pressure in the vessel  Increase vessel size  Rupture


    Aneurysm formation
    Make sure it is Hemoptysis

    DDx:
    • Hematemesis
    • Epistaxis
    • Other nasopharyngeal
    bleeding
    Hemoptysis Hematemesis
    1 Cough + -

    2 Sputum Frothy Rarely frothy Brown to black


    Bright red -pink Liquid or Coffee ground
    clotted

    3 Respiratory + -
    symptoms

    4 Gastric or Hepatic - +
    disease

    5 Vomiting & - +
    Nausea

    6 Melena - +

    7 Asphiyxia usual unusual


    8 Laboratory Alkaline pH;Mixed with Acidic pH;Mixed with food
    Parameters macrophages and particles
    20
    neutrophils
    Causes
    • Infections remain the major cause of hemoptysis
    of which Bronchitis is the major cause.
    CAUSES
    Involvement of Bronchi and Bronchioles:
    1) Bronchitis
    2) Adenoma
    3) Carcinoma
    4) Bronchiectasis
    5) Foreign body
    6) Tuberculosis
    • Involvement of Lung parenchyma
    1) Tuberculosis
    2) Trauma
    3) Lung abscess
    4) Pneumonia
    5) Parasites ( Hydatid, fluke)
    6) Invasive fungal infection.
    • Involvement of lung Vasculature
    1) Pulmonary embolism
    2) Goodpasture’s syndrome
    3) mPAN
    4) Granulomatous polyangitis.
    5) Bronchial artery aneurysm
    6) AV malformations
    7) SLE
    • Cardiovascular causes
    1) Acute LV failure
    2) Mitral stenosis
    • Hematological causes
    1) Thrombocytopenia
    2) Leukemia
    3) Hemophilia/Clotting disorder
    • Other causes
    1) Uremia- Platelet dysfunction.
    2) Catamenial hemoptysis
    3) Inhalation of toxic fumes
    INITIAL STEPS

    1. IDENTIFY WHICH SIDE IS BLEEDING


    2. POSITION THE PATIENT
    3. ESTABLISH A PATENTAIRWAY
    4. ENSURE ADEQUATE GAS EXCHANGE
    5. ENSURE ADEQUATE CVS FUNCTION
    6. CONTROL THE BLEEDING
    Selective Intubation

    SINGLE LUMEN ETT

    Selectivelyintubate
    the non bleeding lung.

    Selective intubation of L Main bronchus


    in R sided massive hemoptysis
    History
    • Does the patient have known pulmonary, cardiac, or renal
    disease?- smoke?
    • Prior hemoptysis, other pulmonary symptoms, or
    infectious symptoms?
    • FH of hemoptysis, brain aneurysms, epistaxis, or GI ? a
    skin rash?
    • Exposed to asbestos?
    • Bleeding disorder? DVT risk?
    • DRUGS?
    • Has the patient had (TB) or been exposed to TB?
    Physical Examination

    • Telangiectasias
    • Skin rashes.
    • An audible chest bruit or murmur- a large
    pulmonary AV malformation.
    • P2, TR ,Heart murmurs –MS.
    • DVT signs
    Laboratory
    tests
    • Type and cross-matching
    • CBC ,COAG
    • Electrolytes, BUN
    • ABG
    • Liver function tests
    • Urinalysis
    • Special tests
    Reference
    • Clinical Anatomy by regions, Richard.S.Snell, 9th edition.
    • Guyton and Hall textbook of medical Physiology, 13th edition.
    • Fishman’s Pulmonary diseases and disorders, 5th edition.
    • Davidson’s principle and practice of medicine, 21st edition.
    • American academy of family Physicians.
    • Harrisons Principles of Internal Medicine, 19 edition.
    • A Clinician’s guide to Tuberculosis, Michael D Iseman.
    THANK YOU

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