2022-05-06-hemoptysis.md (1256B)
1 # hemoptysis 2 3 Scott McCall 4 5 6 ## when to intubate 7 8 if they've already coded, or are very close to it 9 10 if a person is awake enough to cough, 11 they are better at clearing the small airways than we are with suction 12 13 14 ## ABCs 15 16 A - late intubation 17 A - mainstem/positioning (intubate the clear side, put the sick side down) 18 19 B - 20 21 C - ~3L of blood can fit in a typical lung, may need massive transfusion protocol 22 23 24 ## meds 25 26 TXA - if the inhaled drug can get to the problematic areas, e.g. bronchitis/bronchiectasis 27 - literature suggests TXA is helpful if the coagulation cascade is relatively normal (e.g. no mortality benefit in cirrhosis) 28 29 PCC vs FFP - 30 no in vivo or in vitro evidence that 31 drug levels or coagulation parameters are meaningfully improved with PCC, 32 Xa decoy (Andexanet Alfa) does work but is expensive and not often stocked 33 34 Cryo 35 36 37 ## imaging 38 39 CT bronchial artery protocol (CT angio w relatively early shots) 40 41 GGO, can be tree-in-bud (clot) 42 43 ## causes 44 45 - bronchitis/bronchiectasis (in bronchiectasis the vessels are closer to the surface) 46 - PNA 47 - PE (usu late, distal, scant, r/t necrosis) 48 - malignancy - things that recruit VEG-F - thymic, thyroid (papillary), melanoma, Kaposi 49 - cavitary lung lesions (TB, fungal balls, Erasmus formation)