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HAEMOPTYSIS


DEFINITION-
-expectoration of blood or bloody sputum
-potentially lethal or massive hemoptysis > 600 - 800 ml blood in 24 hours.

CAUSES OF HAEMOPTYSIS-
Common -
1. Pulm tuberculosis
2. Bronchial carcinoma
3. Chronic bronchitis
4. Bronchiectasis
5. Lung abscess
6. Pneumonia

Uncommon -
1. Pulm thromboembolism
2.LVF
3.MS
4. Bronchial adenoma
5. Pulm AV malformations
6. Goodpasture's syndrome

INVESTIGATIONS-
1. Blood - Hb level
 -TLC, DLC
- ESR
- BLOOD GROUP
- Platelet count
2. Urine -
 microscopy of red cells & red cell cast
3.Sputum -
 Z-N staining- show acid-fast bacilli
 Klebsiella pneumonia
4. Cytology examination for malignant cells in carcinoma
5. Chest x ray -
  -cystic lesions, ring shadows, tram tracks & grape clusters favours bronchiectasis
  -air-fluid level gives lung abscess
  -fibrotic bands, bronchiectatic changes- pulm t.b.
 -upper lobe consolidation wit bulging interlobar fissure gives diagnosis of klebsiella pneumonia.
-CT chest
-ECG- for MS, Pulm hypertension
-Bronchoscopy- for localising site of bleeding, visual, biopsy or cytologic information
-Isotope lung scan- pulm embolism

TREATMENT-
A) Minor haemoptysis-
1. Scanty - stop spontaneously.
2. Substantial haemoptysis treated by patient calm, bed rest & suppersing cough.
B) potentially lethal m massive haemoptysis -
1. position patient so that side of chest from which bleeding is arising is lowermort.
2.set up an i.v. Infusion & collect blood for grouping & cross matching. Maintain TPR chart.
3. Administer oxygen.
4.blood transfusion.
5. Strong sedatives avoided.
6. Distressing cough suppressed wit linctus codeine 15 ml thrice daily
7. ET intubation if patient has poor gas exchange
8. Double lumen endo tracheal tube
9. Emergency bronchoscopy if bleeding torrential .
10. Bronchial arterial catheterisation
11. Surgical intervention in selected cases.

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