Episode 177.0 – Hemoptysis - a podcast by Core EM

from 2020-02-17T10:45:12

:: ::















An overview and management tips of hemoptysis in the ED.

Hosts:

Brian Gilberti, MD

Audrey Bree Tse, MD







https://media.blubrry.com/coreem/content.blubrry.com/coreem/Hemoptysis.mp3







Download





One Comment











Tags: ,











Show Notes

OVERVIEW:



Definition:



expectoration/ coughing of blood originating from tracheobronchial tree





Sources:



Bronchial arteries (90%): under systemic circulatory pressure to supply supporting structures of the lung ? heavier bleeding

Pulmonary arteries (5%): under low pressure to supply alveoli ? milder bleeding

Nonbronchial arteries (5%): intercostal arteries, coronary arteries, thoracic/ upper/ inferior phrenic arteries





Quantification:



Mild: <20mL/ 24h

Massive defined anywhere from >300mL-1L/ 24hr

Mortality: 38% for massive (>500mL/ 24hr) vs 4.5% for nonmassive









Etiology (in adults):



Infectious (most common):



Bronchitis

PNA (necrotizing, lung abscess)

TB

Viral

Fungal

Parasitic





Malignancy:



Primary lung cancer vs metastatic disease





Pulmonary:



Bronchiectasis

COPD

PE/ infarction

Bronchopleural fistula

Sarcoidosis





Cardiac:



Mitral stenosis

Tricuspid endocarditis

CHF





Rheumatological:



Goodpasture Syndrome

SLE

Vasculitis (Wegener’s, HSP, Behcet)

Amyloidosis





Hematological:



Coagulopathy/ thrombocytopenia/ platelet dysfunction

DIC





Vascular:



Pulmonary HTN

AA

Pulmonary artery aneurysm

Aortobronchial fistula

Pulmonary angiodysplasia





Toxins:



Anticoagulation/ aspirin/ antiplatelets

Penicillamine, amiodarone

Crack lung

Organic solvents





Trauma:



Tracheobronchial rupture

Pulmonary contusion





Other:



bronchoscopy/ lung biopsy

Pulmonary artery or central venous catheterization

Foreign body aspiration

Pulmonary endometriosis (catamenial hemoptysis)

Idiopathic (up to 25% of cases)





Pseudohemoptysis: 



Sinusitis

Epistaxis

Rhinorrhea

Pharyngitis

URI

Aspiration

GIB











WORKUP:



HPI:



CP, SOB

B symptoms: fever, weight loss, chills, night sweats

Lymphadenopathy

Timeframe: acute vs chronic

Prior lung/ renal/ cardiac disease

Recreational drug/ cigarette/ chemical exposures

travel/ infectious exposure

Medications

Any other sites of bleeding

Precipitating factors

Description of blood clots

Further episodes of Core EM - Emergency Medicine Podcast

Further podcasts by Core EM

Website of Core EM