Dr.

Adel Hamada
Lecturer of Chest Diseases
Faculty of Medicine Zagazig University

Chest Diseases symptoms

EMAIL: dr.adel.hamada@gmail.com

Hemoptysis Definition
Expectoration or coughing of blood, or bloody sputum from the lung or tracheobronchial tree.

Differential diagnosis Epistaxis

hematemesis

Hemoptysis
- Red, frothy, fresh bl. - Alkaline pH. - Resp. symptoms. - Bl. Streaked sputum

Hematemesis
- Dark & may contain food particles - Acidic pH. - GIT upset (dyspepsia). - Tarry stool.

causes
Inflammation

Acute and chronic bronchitis. T.B. Pneumonia. Lung abscess Bronchiectasis

Neoplasm Bronchogenic carcinoma. Metastasis Cardiovascular disorders Mitral stenosis Pulmonary infarction Pulmonary edema Trauma Foreign body inhalation Chest trauma.

Dont forget coagulopathy

Management
Evaluation of the patient:
Assessment of severity of hemoptysis

- Mild occasionally blood-streaked sputum. - Moderate persistent blood-streaked. - Massive coughing up 150 cc or more at once. 400 cc or more within 3 hours. 600 cc or more within 24 hours
Massive hemoptysis 1) 2) 3) 4) 5) Endanger patient life Physical exam. hypotension tachycardia tachypnea. Rate of hemorrhage collection of blood in sputum cups. Chest X-ray diffuse opacity large amount. Arterial blood gas analysis hypoxemia in massive one. Hemoglobin level for blood transfusion.

Recognition of the cause and site of bleeding:

History
Mucopurulent sputum infectious disorder. Painful hemoptysis Bronchogenic carcinoma, pneumonia, trauma. Prolonged heavy smoking carcinoma, bronchitis, bronchiectasis. History of contact to tuberculous patient.

Physical exam
General stressing on vital signs (pulse, body temperature, blood pressure and respiratory rate). Local localized rhonchi or rales. Chest X-ray. Sputum exam. ABG Bleeding profile Other investigation as urine analysis.

Investigations

Treatment

A B C
Airway Breathing Circulation

Aim
(1) Patent airways. (2) Adequate gas exchange. (3) Hemodynamically stable patient.

Treatment of Massive Hemoptysis

ICU
positioning Bed rest Double IV line Blood transfusion Codeine sulphate

Initial supportive therapy

ABG Diazepam

monitoring

Bronchoscopy selective endobronchial intubation endobronchial balloon tamponade If bleeding stops treat underlying cause If bleeding continues resectional surgery

Treatment of Moderate Hemoptysis 123456Hospital admission for close observation. Supportive therapy. Treatment of infection if present. Temporary therapy in conjunction with bronchoscopy. If bleeding stops, treat underlying disease. If bleeding persists, proceed as in massive hemoptysis. Treatment of Mild Hemoptysis 1-Treatment of the concurrent infection. 2-Proper management of the cause. 3-If hemoptysis remains unexplained follow up with repeated chest radiography and bronchoscopy has to be performed.

Dyspnea (difficult breathing)

Definition
Subjective uncomfortable awareness of breathing

Causes
Increased demand 1-Physiological exercise, pregnancy, high attitude. 2-Pathological anemia, hyperthyroidism, acidosis. Impaired performance 1-Airflow limitation asthma, emphysema. 2-Reduced lung volume pleural effusion, pneumothorax. 3-Impaired gas exchange pneumonia, pulmonary embolism. 4-Loss of lung compliance consdidation, dema, fibrosis. 5-Loss of thoracic cage compliance ankylosing spondilitis Psychogenic

Grades of dyspnea

-Grade 0 Dyspnea on extraordinary effort. -Grade 1 Dyspnea on ordinary effort. -Grade 2 Dyspnea on less than ordinary effort. -Grade 3 Dyspnea at rest.

Timing
I) Paroxysmal nocturnal dyspnea (PND):
-Occurs 1-2 hrs after sleep.

-Patient complains of dyspnea, cough, no wheezes due to pulmonary congestion cardiac asthma.

II)Dyspnea early in the morning (at dawn) wheezy cough &

dyspnea Bronchial asthma.

III) Dyspnea & cough & expectoration early on first waking in the
morning chronic bronchitis.

Mode of onset and course

1-Sudden onset pulmonary embolism, pneumothorax. 2-Acute inhalation of fumes. 3-Subacute (progressive over weeks) pleural effusion, interstitial lung
disease.

4-Chronic (progressive over months or years) chronic bronchitis,

T.B., interstitial pulmonary fibrosis.

5-Paroxysmal (intermittent) in asthma.

Relation to posture

1)Orthopnea:
heart failure.

Dyspnea in recumbent position, relieved on sitting position as in

2)Platypnea: Dyspnea on assuming upright position as in pulmonary embolism. 3)Trepopnea: Dyspnea in lateral decubitus. It occurs on lying on the healthy side
in unilateral chest diseases.

Abnormal breathing patterns

1)Tachypnea (increased rate): occurs in:
- Dry pleurisy - Fever - Restrictive lung diseases

2)Bradypnea (decrease rate):

3)Hyperpnea (increased depth): occurs in:

It indicates respiratory centre depression due to: - Poisons e.g. opium and barbiturates. - Increased intracranial tension. - Psychogenic conditions. - Metabolic acidosis as diabetic ketoacidosis. - COPD. Shallow breathing is seen in: - Dry pleurisy - Depression of respiratory centre

4)Oligopnea (hypopnea) decreased depth:

- Restrictive lung diseases

* Hyperventilation: -Increased ventilation is proportionately in excess of metabolic needs. -It occurs in: Lesions of midbrain and upper pons. Hystria commonly followed by apnea.