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Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drug, procedures and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and MEDLINE Journals. Explore these free sample topics:
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First Things First (assess & treat for the following)
- FIRST: Protect the airway.
- Any patient with massive hemoptysis should be admitted to a monitored setting.
- Death from hemoptysis usually results from asphyxiation rather than exsanguination.
- Intubation: clinical judgment based on volume & rate of bleeding as well as patient’s cardiopulmonary reserves
- Remember, anatomic dead space only 100-200 ml.
- Use largest ETT possible (8.0 ETT or larger) to facilitate therapeutic bronchoscopy.
- Temporizing measures for specific iatrogenic hemorrhage
- Tracheostomized pt? Apply anterior/downward pressure on tracheal cannula and over-inflate cuff (tracheo-arterial fistula).
- PA catheter balloon recently inflated? (PA rupture): Withdraw catheter slightly and re-inflate balloon to compress bleeding vessel more proximally.
- SECOND: Localize/lateralize the site of bleeding with CXR or FOB.
- Stable vs. unstable pt will alter algorithm.
- CXR may mislead; fails to localize source in 20-50%.
- Urgent bronchoscopy for massive hemoptysis
- Protect non-bleeding lung by positioning patient with bleeding side dependent.
- Unilateral lung intubation may protect non-bleeding lung.
- If R-sided source can selectively intubate L lung over bronchoscope
- If L-sided source can selectively intubate R lung, but risk obstruction of RUL orifice
- If L-sided source can selectively ventilate R lung by intubating trachea and then occluding LUL bronchus with 14 Fr Fogarty balloon catheter
- Use double-lumen ETT only if skilled & knowledgeable practitioner is available; serious consequences with poor positioning.
- Double-lumen ETT will hamper therapeutic bronchoscopy and suctioning due to smaller-diameter lumen.
- THIRD: Resuscitate, supportive care
- Volume resuscitation, evaluate need for transfusion
- Cough suppression: codeine sulfate
- Immediate pulmonary & surgical evaluation
- Rule out pseudohemoptysis.
- Upper GI bleeding
- Nasopharynx or oral cavity bleeding
- Evaluate posterior pharynx & upper larynx.
- Hematemesis usually dark, frequently acidic, may be mixed with food particles
- Hemoptysis usually bright red, frothy, alkaline pH
- FOURTH: Provide definitive and specific treatment (see General Management Principles)
- FINALLY: Prevent recurrent bleeding.
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