SAQ 133 – Respiratory – massive haemoptysis

Question 3. massive haemoptysis.

a. Differentials

• Tuberculosis.
• Pulmonary embolism.
• Severe pneumonia with infarction.
• Primary or secondary lung cancer.
• Pulmonary abscess.
• Coagulopathy or over-anticoagulation.
• Thrombocytopaenia.
• Pulmonary contusion.
• Inhaled foreign body.

b. Investigations

• INR.
• Sputum for AFB and MCS.
• CT chest.
• CTPA.
• ECG, FBE, UEC, LFT, Quantiferon Gold, or echocardiography may also be considered.

c. Next 30 minutes

• Communicate using an interpreter, obtain focused history, and explain treatment to the patient.
• Nurse affected side down to preserve the unaffected lung.
• Provide ventilatory support; consider mainstem intubation, combitube, or dual-lumen tube to ventilate the non-affected side, with anaesthetic assistance.
• Support circulation with volume replacement and blood / massive transfusion if indicated.
• Reverse anticoagulation with FFP, vitamin K, prothrombinex, and consider tranexamic acid as appropriate.
• Treat underlying conditions, for example IV antibiotics for pneumonia or anticoagulation for PE when appropriate.
• Isolate if tuberculosis is suspected.
• Refer to interventional radiology if bleeding persists.