Massive Haemoptysis
This is an anaesthetic crisis
Priority is to: * Decontaminate the airway * Maintain oxygenation
Large haemorrhage into the pulmonary tree, which may precipitate cardiac arrest secondary to hypoxia.
##Emergency Management
Immediately:
- Protect airway
- Large, single-lumen ETT
- Suction cathether/bronchoscopic decontamination
- Consider lung isoation
- Bronchial blocker
- Endobronchial tube
- Large, single-lumen ETT
- Haemodynamic resuscitation
- Cardiac arrest is common
- Hypoxia is almost always the cause
- Hypovolaemia is rarely significant
Definitive treatment:
- Source control
Options include:- Rigid bronchoscopy
- Interventional angiography
Bronchial angiography and embolisation.
- Note risk of paralysis due to loss of spinal perfusion
- Thoracotomy
- Correction of coagulopathy
Epidemiology and Risk Factors
Pathophysiology
- 90% of haemorrhage comes from the bronchial circulation
These bleeds are dependent on systemic blood pressure.
Aetiology
Causes can be divided into:
- Airway
- Primary lung disease
- Primary CVS disease
- Iatrogenic