week 2 hemopthysis - 9 november 2012

7/25/2019 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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week 2 hemopthysis - 9 november 2012

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