#EMconf: Gross Hemoptysis
Hemoptysis:
-Epidemiology: True incidence unknown, males>females, age >40, smoking history
-Anatomy: Lung has duel blood supply: 1) Bronchial arteries (high pressure supporting structures of lungs) 2) Pulmonary arteries (low pressure/supply alveoli)
-Causes: Infectious, neoplastic, cardiovascular, hematologic, alveolar hemorrhage, traumatic, inflammatory, iatrogenic
-Quantifying:
-Massive Hemoptysis:
-Only 5% of cases but 80% of mortality
-Definition varies but from 200ml to 1000ml in 24 hours or >150ml at one time
-If bleeding >1000ml in 24 hours; mortality approaches 60%, 80% association with malignancy
-If bleeding <1000ml in 24 hours; overall mortality <10% but higher with underlying malignancy
-Causes: Bronchiectasis, TB, cavitary lung cancer, lung abscess, tracheobronchial fistula, pulmonary angiodysplasia
-Diagnostic Evaluation: CXR first, then CT and brochoscopy may be necessary
-Treatment: Secure airway first! Threat is asphyxiation, not exsanguination
-Airway Considerations:
-Aim for 8.0 ETT: allows bronchoscopy, suctioning
-Position patient with bleeding lung down if possible
-Selective intubation: intubate normal, non-bleeding lung for ventilation
-Treatment Tips: Transfuse blood products as needed, consider TXA, early pulm/critical care consult, consider angiograpy and embolization, lobectomy/pneumonectomy last resort