basic investigations include:

(i) Full blood count and coagulation studies - massive haemoptysis is >600ml in 24 hours
(ii) Chest X-ray general - massive haemoptysis is usually from a bronchial
(iii) ECG artery (hence blood is lost under systemic pressure)
further investigation includes: investigations
(i) visualisation of the airways with flexible bronchoscopy - tracheobronchitis
(rigid bronchoscopy may be required if bleeding is massive) - gastric aspiration
(ii) CT chest - bronchial adenoma or bronchogenic carcinoma
(iii) echocardiography - bronchial endometriosis
tracheobronchial
- bronchial telangiectasia
disorders
- goals are: - bronchiectasis
(i) to maintain airway patency (of paramount importance because - foreign body aspiration
asphyxia is the commonest mechanism of death in these patients) - tracheo-oesophageal fistula
(ii) to protect the healthy lung - tracheobronchial trauma
(iii) fluid resuscitation - Goodpasture's
- if haemorrhage is occuring from a focal site and the site is known - Legionella
the patient should be positioned with the bleeding site dependent diffuse - SLE
resuscitation
to prevent contamination of the non-involved airways parenchymal - Wegener's
- if haemorrhage is diffuse, the patient should be placed in the diseases - viral pneumonitis
Trendelenburg position - scleroderma
- vasculitidies
- bronchoscopy-guided intubation of the non bleeding mainstem
bronchus or placement of a double lumen ET tube should be - bacterial pneumonia
considered haemoptysis - tuberculosis
- amebiasis
acid base & causes - ascariasis
electrolytes localised
- aspergilloma
abnormalities parenchymal
- coccioidomycosis
- goals are: management diseases
- histoplasmosis X
(i) stop haemorrhage - metastatic cancer
(ii) prevent repeat haemorrhage - nocardiosis
- if a cause is known, specific therapy (such as antibiotics for - lung abscess
bronchiectasis or steroids for pulmonary vasculitis) should be - mitral stenosis
instituted to stop ongoing haemorrhage cardiovascular - pulmonary embolism
- coagulopathies should be corrected specific disorders - CCF
- life-threatening focal haemorrhage may require an aggressive strategy: therapy - fat embolism
(i) bronchial artery embolisation - anticoagulants
(ii) bronchoscopic laser photocoagulation haematological - DIC
(iii) iced normal saline lavage of involved lung segments disorders - leukaemia
(iv) topical adrenaline administration - thrombocytopenia
(v) iv vasopressin
- intubation
(vi) surgery
- suction catheters
evaluation iatrogenic
- tracheoarterial fistula
of underlying - PA rupture
causes