Five Principles for the Management of Massive Hemoptysis

Feb 27, 2023 Source: Cainiu Health

Dr. Guo Xiheng

Introduction

The five general principles for managing massive hemoptysis typically include stabilizing the patient's emotions, which helps reduce bleeding. When the exact source of bleeding cannot be identified, positioning the patient with head low and feet high can help prevent asphyxiation. If asphyxiation has already occurred, an artificial airway must be established. Due to the presence of numerous accompanying symptoms, close monitoring of the patient's condition is essential. Prompt use of medications such as vitamin K injection and etamsylate tablets under medical guidance can help alleviate bleeding.

The five main principles for managing massive hemoptysis typically include stabilizing the patient's emotions, preventing asphyxiation, establishing an artificial airway, close monitoring of the condition, and seeking prompt medical attention.

1. Stabilize Emotions

Due to significant bleeding, it is important to calm and reassure the patient, encourage deep breathing, and maintain emotional stability. This helps reduce vasodilation and minimize further bleeding.

2. Prevent Asphyxiation

When the exact source of bleeding is unclear, positioning the patient with the head lower than the feet (head-down position) facilitates drainage of residual blood from the airway and helps prevent coughing or choking. Additionally, promptly removing blood clots from the mouth can effectively prevent asphyxiation.

3. Establish an Artificial Airway

If asphyxiation has already occurred, endotracheal intubation or tracheotomy is usually required to establish an artificial airway and maintain adequate respiration.

4. Closely Monitor the Condition

Given the presence of various accompanying symptoms, it is essential to closely observe changes in the patient’s condition. This provides critical information for healthcare providers and enables timely implementation of additional emergency interventions.

5. Seek Prompt Medical Attention

Immediate medical care allows for administration of hemostatic medications under a physician’s guidance, such as vitamin K injection, etamsylate tablets, or norepinephrine bitartrate injection, to help control and alleviate bleeding symptoms.

Following these management principles can be life-saving and improve treatment outcomes. However, it is also crucial to identify the underlying cause and implement appropriate targeted therapy accordingly.

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What is the standard for grading the amount of hemoptysis?

Hemoptysis refers to bleeding from the lower respiratory tract or lung tissue below the larynx, which is expelled through the mouth as blood-streaked sputum or fresh bloody cough. Clinically, hemoptysis is classified into mild, moderate, and massive hemoptysis based on the volume of bleeding. The amount of hemoptysis does not always correlate directly with disease severity; however, massive hemoptysis requires emergency management, as it can be life-threatening if left untreated.

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How much hemoptysis is considered massive hemoptysis?

Hemoptysis is considered massive when a single episode involves more than 100 ml of blood, or when the cumulative amount over 24 hours exceeds 500 ml. Massive hemoptysis is a common condition in respiratory diseases; however, the causes of hemoptysis are not limited to respiratory disorders. Many diseases can lead to hemoptysis, with the most common ones being respiratory tract diseases.

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Hemoptysis grading criteria

The amount of hemoptysis can be classified as mild, moderate, or massive. The patient's room should be kept quiet, clean, and comfortable. Patients with moderate to massive hemoptysis should remain in bed (patients with massive hemoptysis must have absolute bed rest) and avoid emotional anxiety and tension as much as possible. If a patient with massive hemoptysis experiences asphyxiation, family members should quickly assist the patient into a head-down, feet-up position and immediately call the emergency number 120.

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Are fungal lung infections serious?

Pulmonary fungal infections are generally quite severe. Such infections can weaken immune function, worsen nutritional status, and may be accompanied by hypoalbuminemia. Without timely treatment, the infection may spread, leading to damage of bronchoalveolar tissues, mucosa, or rupture of bronchial arteries, resulting in massive hemoptysis. If blood clots obstruct the airway, it can easily cause hypoxia, suffocation, and even respiratory failure.