Pulmonary hemorrhage: emergency

Update: November 2018

Pulmonary hemorrhage is an emergency.
characterized by discharge of blood from the lower respiratory tract
coughing This is a serious, often fatal complication of many
lung disease. When detecting its signs is necessary
immediate emergency medical assistance regardless of
causes of the condition. AT ином исходе наступает асфиксия – недостаток
air due to the closure of air cavities in the lungs
by blood.

The reasons

The most common causes of pulmonary hemorrhage are acute and
chronic lung disease:

  1. Traumatic injury (rupture, bruise, stabbed and cut
    wounds of the lung; spontaneous pneumothorax in people with dysplasia
    connective tissue; fracture of ribs with pulmonary damage
    fabrics).
  2. Pulmonary tuberculosis.
  3. Bronchiectasis.
  4. Pulmonary embolism (pulmonary embolism).
  5. Occupational diseases – pneumoconiosis (silicosis,
    anthracosilicosis, siderosilicosis, silicatosis, berylliosis, aluminosis and
    etc.).
  6. Malignant neoplasms (various types of cancer
    lung).
  7. Lymphomas.
  8. Benign neoplasms.
  9. ATоспалительные заболевания – пневмония, микозы, паразитарная
    infection, abscess, gangrene.
  10. Defects свертывающей системы (ДATС-синдром, гемофилия,
    тромбоцитопении, тромбоцитопатии и etc.).
  11. Aneurysms (expansion of the wall) of the pulmonary vessels.
  12. Foreign bodies in the respiratory tract.
  13. Endometriotic lesions in the lung tissue.
  14. Mitral valve defects of severe severity.

In addition, the discharge of blood from the lungs may accompany a number
diagnostic and therapeutic procedures:

  1. Biopsy of lung tissue, bronchus.
  2. Puncture of the pleural cavity.
  3. Installation of pleural drainage.
  4. The period after surgery on the lungs.
  5. Bronchoscopy.

About 40% of pulmonary bleeding is associated with tuberculosis
process, 30% – with a bacterial infection. If the reason was
tissue breakdown in lung cancer, the frequency of occurrence is
about 15-20%.

Speaking of vessels damaged during the development of bleeding from
light, there are two main sources:

  1. Bronchial arteries included in a large circle
    blood circulation.
  2. ATетви легочной артерии, представляющие часть малого круга
    blood circulation.

Worse, if bleeding occurs from the pulmonary artery system,
the branches of which have the largest diameter, rather than
bronchial vessels. Consequently, the bleeding is more intense and worse.
amenable to conservative methods of hemostasis (medicinal
drugs).

Damage to the bronchial branches often accompanies chronic
pulmonary pathology (pneumoconiosis, tuberculosis, neoplasm,
бронхоэктазы и пр.), кровь при этом имеет яркий алый Colour. Defects
pulmonary vessels are more common with pulmonary embolism, pneumonia, pouring
the blood is darker because belongs to the venous bed. Lung injury
captures damage to both types of vessels.

Classification

According to external manifestations, there are two varieties of this
emergency state: hemoptysis and directly pulmonary
bleeding. The first is characterized by visually distinguishable
streaked with blood in the total mass of coughing up sputum either
individual blood spitting. The second is characterized by abundant
constantly coughing up blood volumes.

From a practical point of view, the most useful classification by
the amount of blood obtained, reflecting the severity of the condition
patient:

The severity of pulmonary hemorrhage The volume of lost blood, ml
I BUT 50 per day
B 50-200 per day
AT 200-500 per day
II BUT 30-200 per hour
B 200-500 per hour
III BUT 100 immediately (simultaneously)
B over 100 and / or complete airway blockage with development
asphyxia

Начиная со II B степени, потери крови при легочном кровотечении
regarded as life threatening patient and require more
action to stop it.

Symptoms

Usually patients notice the appearance of the blood itself or its impurities in
мокроте при coughing Signs of pulmonary bleeding include
discharge of bright scarlet frothy blood without clots. ATспенивается она
due to mixing with air bubbles in the respiratory tract.
If only hemoptysis is present, the blood looks like
small streaks on a normal background. AT некоторых случая
hemoptysis is a precursor to the development of full bleeding from
lung tissue.

Given the variety of causes of this condition, the patient can
meet other symptoms of pulmonary hemorrhage. They rather
characterize the severity of the causative disease and can be
expressed in varying degrees:

  • Increased body temperature.
  • Bоли в грудной клетке с усилением их при глубоком дыхании.
  • The feeling of lack of air.
  • Dyspnea.
  • Notмотивированное снижение массы тела за небольшой промежуток
    of time.
  • Periodic discharge of purulent sputum.
  • Tendency to bleedings of other localizations.
  • Muscle and joint aches.

If you lose a lot of blood, symptoms appear.
�”Centralization of blood circulation”. Those. the body is trying to strengthen
blood flow in a fallen volume of circulating blood. To them
include increased heart rate, respiration, pallor of the skin,
sticky sweat, crawling on the surface of the body, fly
before your eyes.

Diagnostics

When stable (no change in pressure, breathing
smooth, symmetrical pulse, normal frequency) of the victim
sputum should be collected in a container to evaluate
approximate volume of blood in it. Conduct a medical examination
including:

  1. Analysis of patient complaints, paying attention to age and changes
    symptoms in dynamics.
  2. Auscultation of the lungs (moist rales may be heard,
    especially in the lower areas).
  3. Measurement of body temperature.

At the stage of providing medical care in a hospital
perform the following diagnostic methods:

  • general blood analysis;
  • biochemical blood examination;
  • coagulogram;
  • electrocardiography;
  • echocardiography;
  • microscopy of collected sputum;
  • sputum culture;
  • determination of blood group and Rh factor;
  • chest radiography;

The most informative is spiral computed tomography (CT),
which allows you to determine the source of bleeding in 80% of cases.
In life-threatening types of pulmonary bleeding, all diagnostic
Manipulations are made in the conditions of reanimation departments.

Differential diagnostics

First of all, it is necessary to assess the presence of signs of gastric
bleeding due to the proximity of the organs of these systems. AT
unlike pulmonary, the blood has no gastric bleeding.
scarlet and does not foam, vomiting is present among the symptoms
�”Coffee grounds” (dark brown or almost black vomit,
in which there is blood, chemically oxidized gastric
juice). For bleeding from the vessels of the esophagus is also not typical
frothy kind of blood, but it is usually lighter than with
gastric bleeding.

ATажно не спутать кровь из легких с кровью из ротовой полости,
pharynx and nose pouring out in small portions from their damaged
mucous membrane. Foaminess is absent, but scarlet is preserved
Colour.

First aid

First aid for pulmonary hemorrhage should always begin.
with an ambulance call. You need to introduce yourself,
briefly and informatively describe the situation, do not forget to call the address. Not
let the patient tilt his head back. Best position
patient with bleeding – sitting with the body and head tilted forward
or lying on the affected side with his head turned to the side. AT
further when transporting the person is laid into position
Fowler – lying on his back, raising his head by 15 degrees.
This is done in order to prevent blood spillage and / or
sputum in a healthy lung and also for the convenience of their
coughing up

To pre-medical assistance include the release of the victim from
constricting clothing (belts, collars, scarves, etc.). Open the windows,
thus providing fresh air to the room.
Constantly stay close to the patient, controlling the level
blood pressure and respiratory rate. Ensure that the patient does not
made sudden movements, it is better that he was at all
motionless, not talking.

To render first aid for pulmonary hemorrhage
attracted all the people around the patient, turned out to be close to
the moment of manifestation of clinical signs.

ATрачебная помощь

Patients with bleeding grades I-II A
hospitalized urgently in the department of thoracic
surgery, while victims with II A degree are placed in the ward
intensive care. Life threatening bleeding is treated in
resuscitation wards.

The action algorithm for pulmonary hemorrhage begins with the installation
venous catheter into one of the veins of the upper limbs (usually
elbow) and oxygen therapy with nasal catheters. In order to reduce
coughing attacks give antitussive pills:

  • Codeine on 0,005-0,02 gr.
  • Ethylmorphine hydrochloride (Dionin) at 0.01 g.
  • Hydrocodone phosphate 0,005 gr.

Intravenous administration is necessary to stop bleeding.
tranexamic acid (Tranexam), 10 ml each (2 ampoules) x 2-3 times a
day. With elevated blood pressure it is produced
reduction with intravenous luminal
venous vessels:

  • Nitroglycerin 0.1% by 0.16-0.25 µg per 1 kg of body weight in
    a minute
  • Sodium nitroprusside 0.25-10 µg per 1 kg of body weight in
    a minute

With pronounced loss of its intravascular blood volume
fill with 0.9% sodium chloride solution, 5% solution
glucose.

If as part of emergency care for pulmonary hemorrhage
it was possible to determine its exact source;
one of the endoscopic methods of hemostasis:

  1. Therapeutic and diagnostic fibrobronchoscopy in combination with
    the introduction of hemostatic solutions, adrenaline into the bronchial tree,
    temporary blockage of the bronchus lumen with a special balloon.
  2. ATнутрисосудистая эмболизация (закрытие) артерии.

The use of drugs and endoscopic hemostasis in pulmonary
bleeding is a temporary measure. Usually only mild bleeding
severity can stop using these methods. AT остальном же
planned surgery depending on the main
diseases of the patient. If possible, it is held in the first 48
hours from onset of symptoms:

  1. Lung resection
  2. Ligation of the bronchus, blood vessels at different levels.
  3. Removal of tubercular cavities, etc.

Where to turn

When symptoms like pulmonary bleeding appear,
It is obligatory to call an ambulance crew, which includes
paramedic or doctor, nurse, nurse. Only if available
small streaks in sputum can independently get to
office of general practitioner or paramedic, as well as to
emergency department (if available in the local
hospitals).

Pulmonary hemorrhage is a serious condition that requires
urgent measures to eliminate it as quickly as possible.
When the first signs of this pathology appear, it is impossible to delay
call a doctor. Otherwise, there is a threat of both anemia and
significant blood loss with the development of shock and a fall in the arterial
pressure.

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