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Massive haemoptysis (expectoration of >200ml blood in 24hrs) (Cause…
Massive haemoptysis (expectoration of >200ml blood in 24hrs)
Cause
Cancer
Active TB followed by bronchiectasis
Trauma
Secondary to a PAFC
Management
Resuscitation
Life threatening emergency: risk of death from asphyxia
100% 02
Lateral position with suspected bleeding side down and head down to prevent aspiration into the uninvolved lung
Large bore IV access, Xmatch blood
Lung isolation
RSI (stomach likely full of blood)
Method will depend on availability of eqpt (and airway assessment)
Endobronchial intubation with SLT
Useful if already intubated or in extremis, but does not allow suctioning and bronchoscopic exam
Advance ETT past carina (? RMB) and inflate cuff
If ETT blood stops, bleeding is controlled in left lung
If ETT blood continues, pass Fogarty catheter via ETT and inflate, then withdraw ETT to trachea to allow ventilation of left lung
DLT
Useful if second lung function is poor prior to bleeding
Difficult to suction large amounts of blood through the narrow lumens
Bronchial blocker
Will normally pass easily into the right mainstem bronchus
Useful for right-sided haemorrhage (=90% of PAFC-induced haemorrhages)
FOB not helpful in the presence of torrential bleeding - guide lung isolation by clinical signs, particularly auscultation
Diagnosis and definitive therapy
Bronchoscopy
Either rigid or fiberoptic
Rigid provides better scope for suctioning but does not allow visualisation of upper lobes and peripheral lesions
Fiberoptic can be performed at bedside
Intervention radiology - embolisation
Surgery