Severe hemoptysis is a true challenge. Due to the rarity of this condition, there is little high-quality data on it. So you can't become a hemoptysis whisperer by reading articles. Unfortunately, for the same reason, it's also difficult to accumulate clinical experience. A full-time intensivist might only see a few cases each year. I've tried to construct a logical approach to hemoptysis utilizing modern radiologic technologies, but a lot of this chapter is based on thin evidence.
The IBCC chapter is located here.
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IBCCup 2019 (Davidson K and Shojaee S in Chest):
when new articles come out on topics already in the IBCC, I will read them, update the IBCC, and tweet out some pearls from the article as I go. today will cover a new review in CHEST on massive hemoptysis (#IBCCup 1/6) https://t.co/brqaI5Lvgd
— Internet Book of Critical Care (@iBookCC) August 16, 2019
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I just recently had my first experience with a “massive” hemoptysis in a patient with cystic lung disease. The active bleeding stabilized after DDAVP and TXA. TXA was given IV as I didn’t want the nebulizer mask to interfere with her expectoration. TEG was normal. There was some discussion between ED and CCM about placing a DL ET, but ultimately decided against it as it could potentially impede bronchoscopy. On bronchoscopy she had extensive clot burden filling the entire left mainstem that was approaching the carina. In retrospect, I think that the DLT would’ve been significantly more protective. I agree… Read more »
try squirting afrin down the airways.
How much TXA do you give down the bronch (instead of or in addition to the iced saline)?