MANAGEMENT: HAEMOPTYSIS
MANAGEMENT: HAEMOPTYSIS: Cases with mild or moderate degree of haemoptysis may be managed at patient’s house, if so desired. However, hospitalization becomes essential if (i) haemoptysis continues for more than 24 hours; (ii) it is massive, i.e. associated with loss of more than half a litre of blood; and (iii) features of shock have supervened or are impending. ‘In, such circumstances a glucose infusion should be started immediately and continued during transportation of the patient to the hospital.. The precise treatment varies according to the severity of haemoptysis.
(a) Cases with Mild or Moderate Haemoptysis
The sight of one’s own blood coming from the chest is always a source of anxiety and fear to the patient. He should therefore, be reassured and advised to rest in bed, lying on the affected side, if this is known. A mild sedative (e.g., phenobarbitone 100 mg, diazepam 10 mg or pethidine 50 mg) IM may be administered to allay the anxiety. Heavy sedation, especially with narcotics, should be avoided as this may unduly depress the cough reflex and result in choking and asphyxiation.
This is probably all that will be required in patients with minor degree of hagmoptysis.,
(b) Cases with Massive Haemoptysis
A sudden large haemoptysis may occasionally be rapidly fatal, the patient dying before the doctor can reach him. The immediate cause of death in such circumstanees is related, not to actual loss of blood, but to asphyxiation resulting from large amounts of blood flooding the bronchial passages. More often, however, haemoptysis, even though massive, is not quite abrupt and allows time for management. Such cases should be treated as follows:
(i) Sedation. All the measures outlined above under (a) including reassurance, complete bed rest and moderate degree of sedation should be instituted.
(ii) Posture. If the doctor happens to be present at the time of the occurrence of massive haemoptysis, the most important thing to do is to immediately put-the patient in the semi-prone position on the edge of the bed and lower the head. This will facilitate the flow of the blood out from the respiratory passages, thus minimizing risk of asphyxiation.
(iii) Blood Transfusion. This is indicated in all cases of massive haemoptysis especially if there is a fall in blood pressure and the patient develops features of shock. In such cases a rough estimate of the amount of blood lost should be made by: (a) noting the quantity of the coughed up blood; (b) a careful physical examination of the patient; and (c) haemoglobin estimation. The last may not, however, show a fall pari passu with the degree of blood loss and thus may be misleading if done soon after the massive bleed since it may take 24-28 hours for equilibrium to be established between extravascular and intravascular compartments.
The hypovolaemia resulting from loss of blood is best treated by replacement with an almost equal quantity of blood. How-ever, till such time as blood transfusion is arranged, 5 percent glucose and normal saline or other fluids such as dextran should be given to increase the blood volume. The latter (dextran) has a high molecular weight and has the advantage of increasing the circulating blood volume by enhancing oncotic pressure.
(iv) Drugs. (a) Antibiotics.li has already been mentioned that all cases of haemoptysis with more than trivial bleed run the risk of developing aspiration pneumonia. Such cases usually develop a mixed infection and therefore broad-spectrum antibiotics such as ampicillin alone or with gentamycin should be given in usual dosage for 1-2 weeks. If possible, a sputum culture and sensitivity report should be obtained to guide the antibiotic therapy. However, such tests are often unreliable and difficult to interpret revealing, not infrequently, only normal flora even in the presence of overt chest infection.
When haemoptysis is due to tuberculosis appropriate antitu-bercular treatment should be administered on a long .term basis in addition to broad-spectrum antibiotics mentioned above.
(b) Many other drugs such as calcium gluconate, oestrogens, clauden, vitamin K etc., are often advocated to control bleeding, but their efficacy is doubtful.
Tags: calcium gluconate, clauden, haemoptysis, hypovolaemia, oestrogens, Sedation
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