STUDY - Technical - New Dacian's Medicine
Hemoptysis
(Classical / Allopathic Medicine)
Frightening to the
patient and usually ominous, hemoptysis is the expectoration
of blood or bloody sputum from the lungs or tracheobronchial
tree. It's sometimes confused with bleeding from the mouth,
throat, nasopharynx, or GI tract. Expectoration of 200 ml of
blood in a single episode suggests severe bleeding, whereas
expectoration of 400 ml in 3 hours or more than 600 ml in 16
hours signals a life-threatening crisis.
Hemoptysis usually
results from chronic bronchitis, lung cancer, or
bronchiectasis. However, it may also result from an
inflammatory, infectious, cardiovascular, or coagulation
disorder or, rarely, from a ruptured aortic aneurysm. In up to
15% of patients, the cause is unknown. The most common causes
of massive hemoptysis are lung cancer, bronchiectasis, active
tuberculosis, and cavitary pulmonary disease from necrotic
infection or tuberculosis.
A number of
pathophysiologic processes can cause hemoptysis.
ALERT:
If the patient coughs up copious amounts of blood:
- maintain his airway
- prepare for endotracheal intubation, if appropriate
- prepare for an emergency bronchoscopy, if necessary
- take his vital signs, and look for signs of shock.
If the hemoptysis is mild, perform a focused assessment.
If the patient coughs up copious amounts of blood:
- maintain his airway
- prepare for endotracheal intubation, if appropriate
- prepare for an emergency bronchoscopy, if necessary
- take his vital signs, and look for signs of shock.
If the hemoptysis is mild, perform a focused assessment.
HISTORY:
Ask the patient when the hemoptysis began. Has he ever coughed up blood before?
Ask the patient how much blood he's coughing up and how often.
Review the patient's medical history for cardiac, pulmonary, and bleeding disorders.
Obtain a drug history, including prescription and over-the-counter (OTC) drugs, herbal remedies, and recreational drugs. If the patient is receiving anticoagulant therapy, find out the name of the drug, its dosage and schedule, and the duration of therapy. Also, ask him about his alcohol intake.
Ask the patient if he smokes. If so, establish how many packs per year he smokes.
Ask the patient when the hemoptysis began. Has he ever coughed up blood before?
Ask the patient how much blood he's coughing up and how often.
Review the patient's medical history for cardiac, pulmonary, and bleeding disorders.
Obtain a drug history, including prescription and over-the-counter (OTC) drugs, herbal remedies, and recreational drugs. If the patient is receiving anticoagulant therapy, find out the name of the drug, its dosage and schedule, and the duration of therapy. Also, ask him about his alcohol intake.
Ask the patient if he smokes. If so, establish how many packs per year he smokes.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs, and examine his nose, mouth, and pharynx for sources of bleeding.
Inspect the configuration of the patient's chest, and look for abnormal movement during breathing, use of accessory muscles, and retractions. Observe his respiratory rate, depth, and rhythm.
Examine the skin for lesions.
Palpate the chest for diaphragm level and for tenderness, respiratory excursion, fremitus, and abnormal pulsations; then percuss for flatness, dullness, resonance, hyper resonance, and tympany. Auscultate the lungs, paying attention to the quality and intensity of breath sounds.
Auscultate for heart murmurs, bruits, and pleural friction rubs.
Obtain a sputum sample and examine it for overall quantity, for the amount of blood it contains, and for color, odor, and consistency.
Take the patient's vital signs, and examine his nose, mouth, and pharynx for sources of bleeding.
Inspect the configuration of the patient's chest, and look for abnormal movement during breathing, use of accessory muscles, and retractions. Observe his respiratory rate, depth, and rhythm.
Examine the skin for lesions.
Palpate the chest for diaphragm level and for tenderness, respiratory excursion, fremitus, and abnormal pulsations; then percuss for flatness, dullness, resonance, hyper resonance, and tympany. Auscultate the lungs, paying attention to the quality and intensity of breath sounds.
Auscultate for heart murmurs, bruits, and pleural friction rubs.
Obtain a sputum sample and examine it for overall quantity, for the amount of blood it contains, and for color, odor, and consistency.
SPECIAL
CONSIDERATIONS:
Place the patient in a slight Trendelenburg position to promote drainage of blood from the lung.
Place the patient in a slight Trendelenburg position to promote drainage of blood from the lung.
PEDIATRIC
POINTERS:
Hemoptysis in children may stem from Goodpasture's syndrome, cystic fibrosis, or (rarely) idiopathic primary pulmonary hemosiderosis.
Hemoptysis in children may stem from Goodpasture's syndrome, cystic fibrosis, or (rarely) idiopathic primary pulmonary hemosiderosis.
AGING ISSUES:
If the patient is receiving an anticoagulant, determine changes that need to be made in his diet or drug therapy (including OTC drugs and herbal remedies) because these factors may affect clotting.
If the patient is receiving an anticoagulant, determine changes that need to be made in his diet or drug therapy (including OTC drugs and herbal remedies) because these factors may affect clotting.
PATIENT
COUNSELING:
Many chronic disorders cause recurrent hemoptysis. Instruct the patient to report recurring episodes and to bring a sputum specimen containing blood when he returns for reevaluation. Comfort and reassure the patient, who may react to this alarming sign with anxiety and apprehension.
Many chronic disorders cause recurrent hemoptysis. Instruct the patient to report recurring episodes and to bring a sputum specimen containing blood when he returns for reevaluation. Comfort and reassure the patient, who may react to this alarming sign with anxiety and apprehension.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)