RESPIRATORY

ResponseHistory
Underlying causes (Lung disease, cardiac, FHx, autoimmune, infective, PE, smoking, recent procedures)
Meds - anticoagulation, illicit drugs
Travel history + country of origin

Examination
Exclusion of other sources of bleed (Eg Pharynx)
Airway - patency, oxygenation, ventilation
Haemodynamics.

ResponseBronchiectasis
TB
Cancer - bronchogenic lung, mets to lung
Immune lung disease (Goodpastures, Wegeners’ granulomatosis)
Vascular malformations (eg AVM)
Thoracic aortic aneurysm
Lung abscess
Necrotising lung infection eg: S. Aureus
Iatrogenic - post procedure
PE (especially septic emboli)
Coagulopathy
Cardiac eg: Mitral stenosis

BATTLECAMP
Bronchitis/Bronchiectasis
Aspergilloma
Tumour
TB
Lung abscess
Emboli
Coagulopathy
Autoimmune/AV malformation/Alveolar haemorrhage
Mitral stenosis
Pneumonia

ResponseHb - guide packed cell replacement, define severity of blood loss
ABG - quantify degree of hypoxia/resp compromise/need for invasive ventilation
Coags - exclude coagulopathy contributing
CXR - Looking bronchiectasis, infection/abscess, SOL. Identify which lung is bleeding to guide management
CTA Chest - look for blush to guide management - IR embolisation, diagnose cause
Renal function - if suspected vasculitis eg: Wegeners
G+H ?

ResponseLateral decubitus with suspected bleeding side down, prepare for intubation
Resuscitation with blood products and correction of bleeding diathesis - temp/ca/plt and anticoagulation reversal
Tranexamic acid nebulised - 500 mg-1 g - can be repeated
Intubation - consider advancing tube into non bleeding lung for single lung ventilation or double lumen tube
Urgent IR if bleeding source identified or balloon tamponade once intubated.
Urgent bronchoscopy
Antibiotics to cover cause - should cover pseudomonas - Tazocin.

ResponseConservative - if no ongoing bleeding
IR embolisation - if active bleeding blush on CT and IR available
Thoracotomy - ongoing bleeding not amenable to IR + surgeon available
Endoscopic - minor haemoptysis if settled