week 2 hemopthysis - 9 november 2012
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HEMOPTYSISHEMOPTYSIS
Allen WidysantoAllen Widysanto
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DEFINITIONDEFINITION
Hemoptysis is defined as the spitting ofHemoptysis is defined as the spitting of
blood dei!ed fom the l"ngs o bon#hialblood dei!ed fom the l"ngs o bon#hial
t"bes as a es"lt of p"lmonay ot"bes as a es"lt of p"lmonay o
bon#hial hemohagebon#hial hemohage
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$%ASSIFI$ATION$%ASSIFI$ATION
HEMOPTYSIS
MASSIVE NONMASSIVE
NO DEFINITE CRITERIA
&lood loss less than '(( ml&lood loss '(()*((( ml+', ho"s
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Massi!e hemoptysisMassi!e hemoptysis
P"lmonology and -espiatoy DepatmentP"lmonology and -espiatoy Depatment
at F./I +Pesahabatan Hospital has o0nat F./I +Pesahabatan Hospital has o0n
#iteia1#iteia1
&lood loss 2 3(( ml+', ho"s and it doesn4t stop on obse!ation
&lood loss 2 '5( ml b"t 6 3(( ml+', ho"s7 Hb le!el
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$a"ses$a"ses
PULMONARY EXTRA PULMONARY
T"be#"losis
E< T"be#"losis
%"ng #an#e
&on#hitis
&on#hie#tasis
F"ngal infe#tion
THE MOST IMPORTANT IS THE SOURCE
OF HEMOPTYSIS
/ppe -espi Ta#t
=IT
Dental+g"m
PH)MS
$oag"lopathy
idiopathic
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PATHOPHYSIO%O=YPATHOPHYSIO%O=Y
TUBERCULOSIS
Ane"ysme -asm"ssen
%ymphadenopathy
&on#hie#tasis
Non spci!ic
in!ction
S"pefi#ial m"#osa inflammation may lead
-"pt"e of S"pefi#ial blood !essel
ba#teial !i"s f"ngi
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LUN" CANCERS"pefi#ial m"#osal in!asion
Eosion into blood !essel
Angiogenesis
Se#onday infe#tion
CARDIAC %eft !enti#"la HF
Mital Stenosis
IT IS DEPEND ON THE CAUSES
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Hemoptysis in #hildenHemoptysis in #hilden
%OWE- -ESPI-ATO-Y T-A$T INFE$TION
FO-EI=N &ODY ASPI-ATION
&-ON$HIE$TASIS
P/%MONA-Y T& 11 >ey ae
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Hemoptysis !s HematemesisHemoptysis !s Hematemesis
Absen#e of na"sea and !omiting Pesen#e of na"sea and !omiting
%"ng disease =asti# o hepati# disease
Asphy
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DIA=NOSTI$DIA=NOSTI$
histoy ta@inghistoy ta@ing$%INI$A% $%/ES$%INI$A% $%/ES S/==ESTED DIA=NOSISS/==ESTED DIA=NOSIS
Anti#oa"lant "seAnti#oa"lant "se Medi#ation effe#t7 #oag"lation disodeMedi#ation effe#t7 #oag"lation disode
Asso#iation 0ith mensesAsso#iation 0ith menses $atamenial hemoptysis$atamenial hemoptysis
Dyspnea on e7 imm"nos"ppesion Neoplasia7 t"be#"losis7 .aposi4s sa#omaNeoplasia7 t"be#"losis7 .aposi4s sa#oma
Na"sea7 !omiting7 melena7 al#oholism7 #honi# "se of NSAIDNa"sea7 !omiting7 melena7 al#oholism7 #honi# "se of NSAID =astitis7 gasti# o pepti# "l#e7 esophageal !ai#es=astitis7 gasti# o pepti# "l#e7 esophageal !ai#es
Ple"iti# #hest pain7 #alf tendenessPle"iti# #hest pain7 #alf tendeness P"lmonay embolism o infa#tionP"lmonay embolism o infa#tion
Toba##o "seToba##o "se A#"te bon#hitis7 #honi# bon#hitis7 l"ng #an#e7A#"te bon#hitis7 #honi# bon#hitis7 l"ng #an#e7pne"moniapne"monia
Ta!el histoyTa!el histoy T"be#"losis7 paasites7 biologi# agentsT"be#"losis7 paasites7 biologi# agents
Weight lossWeight loss Emphysema7 l"ng #an#e7 t"be#"losis7bon#hie#tasis7Emphysema7 l"ng #an#e7 t"be#"losis7bon#hie#tasis7l"ng abs#ess7 HI>l"ng abs#ess7 HI>
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DIA=NOSTI$DIA=NOSTI$
Physi#al E
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DIA=NOSTI$ E>A%/ATIONDIA=NOSTI$ E>A%/ATION
Histoy ta@ingHistoy ta@ing
Physi#al e
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Haison *5th7ed1
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Management Nonmassi!eManagement Nonmassi!e
HemoptysisHemoptysis=oal=oal
&%EEDIN= $ESSATION
ASPI-ATION P-E>ENTION
T-EATMENT /NDE-%YIN=
AIR)AYBREATHI
N"CIRCULATI
ON
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C Depends on the "ndelying disease1Depends on the "ndelying disease1
C Sedati!es Fenobabital *()'5 mg+, ho"s oSedati!es Fenobabital *()'5 mg+, ho"s o%ibi"m *()'5 mg+ho"s%ibi"m *()'5 mg+ho"s
C $odein s"lfat *5)( mg+,am$odein s"lfat *5)( mg+,am
C If bleedingIf bleeding '()*(( ## '()*(( ## *1*1 I> lineI> line
'1'1 Monitoing $>PMonitoing $>P
11 $omplete blood #o"nt plateletG$omplete blood #o"nt plateletG,1,1 Ele#tolyteEle#tolyte
5151 PT)APTTPT)APTT
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I$/ setting if neededI$/ setting if needed
&on#hos#opy&on#hos#opy
S"gi#al if bleeding 9 *5( ml+ho"7 "seS"gi#al if bleeding 9 *5( ml+ho"7 "sedo"ble l"men ETTdo"ble l"men ETT
Fogathy #atheteFogathy #athete
P"lmonay atey emboliationP"lmonay atey emboliation
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Management of massi!eManagement of massi!e
hemoptysishemoptysis*1*1 >ital sign >ital sign C O@sigenO@sigenC Defi#it !ol"me #olloid+#istaloid7 blood tansf"sionDefi#it !ol"me #olloid+#istaloid7 blood tansf"sion
if hemato#it 6 '5)(8 o Hb 6 *( g87 bleedingif hemato#it 6 '5)(8 o Hb 6 *( g87 bleeding
still o##"Gstill o##"GC &lood pess"e !asopesso dob"tamin dan&lood pess"e !asopesso dob"tamin dandopaminGdopaminG
'1 A!oid ai0ay obst"#tion'1 A!oid ai0ay obst"#tionC Tendelenbeg positionTendelenbeg positionC ETTETTC S"#tionS"#tionC Me#hani#al !entilatoMe#hani#al !entilato
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1 Stop bleeding1 Stop bleeding
&on#hos#opy #ito inset the Fogathy&on#hos#opy #ito inset the Fogathy
#atheteG#atheteG
&on#hial atey #atheteiation7&on#hial atey #atheteiation7
emboliationemboliation
Hemostati# agent is still "n#leaHemostati# agent is still "n#lea Antit"ssi!e $odein *()'( mg+, ho"sGAntit"ssi!e $odein *()'( mg+, ho"sG
Hemostati# physiologyHemostati# physiology
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,1 Spe#ifi# theapy,1 Spe#ifi# theapy
Tho"gh bon#hos#opeTho"gh bon#hos#ope
&on#hial 0ashing "sing #old Nomal&on#hial 0ashing "sing #old NomalSaline Na$l (18GSaline Na$l (18G
>aso#onsti#to agent adenalin>aso#onsti#to agent adenalin
Endobon#hial tamponadeEndobon#hial tamponade%ase Neodynami"m)al"mini"m)ganet%ase Neodynami"m)al"mini"m)ganet
Nd)YA=GNd)YA=G
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Witho"t bon#hos#opeWitho"t bon#hos#ope
Teat the "ndelying diseaseTeat the "ndelying disease
I> !asopessin (7')(7, "nit+minI> !asopessin (7')(7, "nit+minAntifibinoliti#Antifibinoliti#
-adiasi ))) !as#"la thombosis-adiasi ))) !as#"la thombosis
Atey emboliationAtey emboliation
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MANA"EMENT OF MASSIVEMANA"EMENT OF MASSIVE
HAEMOPTYSISHAEMOPTYSIS
Ai'*a( p'otction and 's#scitationAi'*a( p'otction and 's#scitation
Idnti!(in+ th sit and ca#s o!Idnti!(in+ th sit and ca#s o!
&,din+&,din+B'onchoscopic t'at$ntB'onchoscopic t'at$nt
B'onchia, a't'( $&o,i-ation .BAE/B'onchia, a't'( $&o,i-ation .BAE/
S#'+ica, t'at$ntS#'+ica, t'at$nt
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SUR"ICAL MANA"EMENTSUR"ICAL MANA"EMENT
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, ta@e home messages, ta@e home messages
Find o"t the #a"ses of hemoptysisFind o"t the #a"ses of hemoptysis
-emembe the goal of management-emembe the goal of management
Asphy
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