EMCrit Podcast 199 – Management of Massive Hemoptysis with Oren Friedman - a podcast by Scott D. Weingart, MD FCCM
from 2017-05-14T19:13:04
Today, I am joined by my buddy and pulmonary-critical care stud, Oren Friedman, to discuss the management of Massive Hemoptysis
See More from Oren
* Clot Management of Massive and SubMassive PE
* Hemodynamic Management of PE
Some Basics on Massive Hemoptysis
* LitFL
* First10 EM
* Review by Sakkour on Massive Hemoptysis
* IBCC chapter Severe hemoptysis
* A Wee Bit More on Massive Hemoptysis
Intubate Big
Localize
C-XR, chart review, and initial bronch. Remember Oren's tip: if you get in there and can't find any bleeding, temporarily disconnect the vent
Is it Amenable to Bronch Treatment?
If not, Block; preferably at the segmental level
Use a bronchial blocker, not a double lumen tube
Uni Blocker
EZ Blocker
A poor 2nd choice is mainstem intubation
Bougie for selective lung
Then Get a CTA of the Chest
make sure to order a delayed phase to see the systemic circulation as well
Then go to IR for Bronchial Artery Embolization
95% of the lesions will arrise from the bronchial circulation. The ones that don't are PE, Pulmonary Art Catheter mishaps, and AVMs of the Pulmonary arterial circulation.
If that fails, Surgery or ECMO
Updates
* Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. 2018 Oct 12. pii: S0012-3692(18)32572-8. doi: 10.1016/j.chest.2018.09.026.
* Great Review Article from CHEST
Now, On to the Podcast...
Further episodes of EMCrit Podcast
Further podcasts by Scott D. Weingart, MD FCCM
Website of Scott D. Weingart, MD FCCM