Hemoptysis - Revision history

Rossdonaldson1: /* Clinical Features */

2024-04-24T17:40:07Z

Clinical Features

← Older revision		Revision as of 17:40, 24 April 2024
Line 5:		Line 5:

	==Clinical Features==		==Clinical Features==
			[[File:Krev na gázových čtvercích.jpg\|thumb\|Example of hemoptysis from coughing into gauze.]]
	[[File:Raetchon å sonk.jpg\|thumb\|Example of hemoptysis upon bronchial lavage.]]		[[File:Raetchon å sonk.jpg\|thumb\|Example of hemoptysis upon bronchial lavage.]]
	*Coughing up blood		*Coughing up blood

Rossdonaldson1: /* Clinical Features */

2024-04-24T17:38:49Z

Clinical Features

← Older revision		Revision as of 17:38, 24 April 2024
Line 5:		Line 5:

	==Clinical Features==		==Clinical Features==
			[[File:Raetchon å sonk.jpg\|thumb\|Example of hemoptysis upon bronchial lavage.]]
	*Coughing up blood		*Coughing up blood

Elcatracho: /* Management */

2020-11-29T18:46:56Z

Management

← Older revision		Revision as of 18:46, 29 November 2020
Line 46:		Line 46:
	**If possible can selectively intubate the unaffected bronchus to prevent aspiration		**If possible can selectively intubate the unaffected bronchus to prevent aspiration
	***After tube passes through cords rotate 90degrees left or right and advance		***After tube passes through cords rotate 90degrees left or right and advance
			****Can also use ''coude'' tip of [[bougie]]<ref>Gottlieb M, Sharma V, Field J, Rozum M, Bailitz J. Utilization of a gum elastic bougie to facilitate single lung intubation. Am J Emerg Med. 2016 Dec;34(12):2408-2410. doi: 10.1016/j.ajem.2016.08.057. Epub 2016 Aug 27. PMID: 27614374.</ref>
	*Coagulopathy		*Coagulopathy
	**[[FFP]]		**[[FFP]]

Kxl328: /* Management */

2020-02-15T07:36:11Z

Management

← Older revision		Revision as of 07:36, 15 February 2020
Line 51:		Line 51:
	*Nebulized [[TXA]] 500 mg tid<ref>Wand O, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. DOI: https://doi.org/10.1016/j.chest.2018.09.026</ref>		*Nebulized [[TXA]] 500 mg tid<ref>Wand O, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. DOI: https://doi.org/10.1016/j.chest.2018.09.026</ref>
	**Pediatric: used in [https://www.emrap.org/episode/emrap2018june/case report]		**Pediatric: used in [https://www.emrap.org/episode/emrap2018june/case report]
	*IV [[TXA]] may reduce in-hospital mortality, length of stay, and total healthcare costs.<ref>Kinoshita T, Ohbe H, Matsui H, Fushimi K, Ogura H, Yasunaga H. Effect of tranexamic acid on mortality in patients with haemoptysis: a nationwide study. Crit Care. 2019;23(1):347. Published 2019 Nov 6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836388/</ref>		*IV [[TXA]] may reduce in-hospital mortality, length of stay, and total healthcare costs<ref>Kinoshita T, Ohbe H, Matsui H, Fushimi K, Ogura H, Yasunaga H. Effect of tranexamic acid on mortality in patients with haemoptysis: a nationwide study. Crit Care. 2019;23(1):347. Published 2019 Nov 6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836388/</ref>
			**Absolute in-hospital mortality reduction was 2.5% in the retrospective study of nearly 20,000 patients
			**No particular dosing regimen, but in this study, no association was found between TXA and seizures, in part per the authors, due to most patients receiving no more than 2 g of TXA total
	===Massive===		===Massive===
	*Angle head down with affected lung low		*Angle head down with affected lung low

Hoxbox: /* Management */

2020-01-04T19:12:20Z

Management

← Older revision		Revision as of 19:12, 4 January 2020
Line 51:		Line 51:
	*Nebulized [[TXA]] 500 mg tid<ref>Wand O, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. DOI: https://doi.org/10.1016/j.chest.2018.09.026</ref>		*Nebulized [[TXA]] 500 mg tid<ref>Wand O, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. DOI: https://doi.org/10.1016/j.chest.2018.09.026</ref>
	**Pediatric: used in [https://www.emrap.org/episode/emrap2018june/case report]		**Pediatric: used in [https://www.emrap.org/episode/emrap2018june/case report]
			*IV [[TXA]] may reduce in-hospital mortality, length of stay, and total healthcare costs.<ref>Kinoshita T, Ohbe H, Matsui H, Fushimi K, Ogura H, Yasunaga H. Effect of tranexamic acid on mortality in patients with haemoptysis: a nationwide study. Crit Care. 2019;23(1):347. Published 2019 Nov 6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836388/</ref>

	===Massive===		===Massive===

ClaireLewis: /* References */

2019-10-12T16:06:21Z

References

← Older revision		Revision as of 16:06, 12 October 2019
Line 68:		Line 68:
	<references/>		<references/>
	[[Category:Pulmonary]]		[[Category:Pulmonary]]
			[[Category:Symptoms]]

ClaireLewis: /* Management */

2019-10-12T16:00:42Z

Management

← Older revision		Revision as of 16:00, 12 October 2019
Line 53:		Line 53:

	===Massive===		===Massive===
	#Angle head down with affected lung low		*Angle head down with affected lung low
	#Consider angio embolization		*Consider angio embolization
	#Consider [[intubation]] with >8.0 (for bronch)		*Consider [[intubation]] with >8.0 (for bronch)

	==Disposition==		==Disposition==

ClaireLewis: /* Management */

2019-10-12T15:29:53Z

Management

← Older revision		Revision as of 15:29, 12 October 2019
Line 48:		Line 48:
	*Coagulopathy		*Coagulopathy
	**[[FFP]]		**[[FFP]]
	*~~Emergenct~~ bronchoscopy or embolization for life-threatening hemorrhage		*Emergent bronchoscopy or embolization for life-threatening hemorrhage
	*Nebulized [[TXA]] 500 mg tid<ref>Wand O, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. DOI: https://doi.org/10.1016/j.chest.2018.09.026</ref>		*Nebulized [[TXA]] 500 mg tid<ref>Wand O, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. DOI: https://doi.org/10.1016/j.chest.2018.09.026</ref>
	**Pediatric: used in [https://www.emrap.org/episode/emrap2018june/case report]		**Pediatric: used in [https://www.emrap.org/episode/emrap2018june/case report]

Rossdonaldson1: /* Management */

2019-07-20T10:55:18Z

Management

← Older revision		Revision as of 10:55, 20 July 2019
Line 50:		Line 50:
	*Emergenct bronchoscopy or embolization for life-threatening hemorrhage		*Emergenct bronchoscopy or embolization for life-threatening hemorrhage
	*Nebulized [[TXA]] 500 mg tid<ref>Wand O, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. DOI: https://doi.org/10.1016/j.chest.2018.09.026</ref>		*Nebulized [[TXA]] 500 mg tid<ref>Wand O, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. DOI: https://doi.org/10.1016/j.chest.2018.09.026</ref>
	**Pediatric: used in [https://www.emrap.org/episode/emrap2018june/ case report]		**Pediatric: used in [https://www.emrap.org/episode/emrap2018june/case report]

	===Massive===		===Massive===

Rossdonaldson1: /* Management */

2019-07-20T10:54:02Z

Management

← Older revision		Revision as of 10:54, 20 July 2019
Line 49:		Line 49:
	**[[FFP]]		**[[FFP]]
	*Emergenct bronchoscopy or embolization for life-threatening hemorrhage		*Emergenct bronchoscopy or embolization for life-threatening hemorrhage
			*Nebulized [[TXA]] 500 mg tid<ref>Wand O, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. DOI: https://doi.org/10.1016/j.chest.2018.09.026</ref>
			**Pediatric: used in [https://www.emrap.org/episode/emrap2018june/ case report]

	===Massive===		===Massive===
	#Angle head down with affected lung low		#Angle head down with affected lung low
	#Consider angio embolization		#Consider angio embolization
	#[[~~Intubate~~]] with >8.0 (for bronch)		#Consider [[intubation]] with >8.0 (for bronch)

	~~===When all else fails===~~
	*Consider Nebulized TXA
	**Adult Patients
	***A [https://www.ncbi.nlm.nih.gov/pubmed/26381600 2015 Case Report] found that nebulized TXA was a safe, effective, and noninvasive method for controlling/temporizing hemoptysis in select patients.
	**Pediatric Patients
	***An [https://www.emrap.org/episode/emrap2018june/coolpedstricks audio case report] on the [https://www.emrap.org/episode/emrap2018june/coolpedstricks July 2018 episode of EMRAP] discussed giving 0.5g of nebulized TXA for a pediatric patient in order to control/temporize hemoptysis.
	**The evidence is limited. However, if you are in the situation where nothing else is working, you might as well try it.

	==Disposition==		==Disposition==