Sun21November0420PM 12

A 75-year-old lady with a history of bronchiectasis presents as an emergency with massive haemoptysis and haemodynamic instability.

Her Hb has dropped to 70 g/L, platelets are 90 ×109/L and her blood pressure is 100 mmHg systolic. She is tachycardic.

You are concerned. You secure intravenous access, administer vitamin K, tranexamic acid and terlipressin bolus. You have also commenced a blood transfusion and broad spectrum antibiotics.

Which of the following should be the next step in this case?

(Please select 1 option)

Intubate Correct

Refer for bronchoscopy

Administer platelet transfusion

Refer for bronchial artery embolisation

Refer for angiography

Explanation

In massive haemoptysis a double lumen endotracheal tube inserted by an experienced anaesthetist can help to tamponade bleeding, protect the non-affected lung and maintain a clear airway, whilst awaiting definitive intervention.

In a stable patient presenting with massive haemoptysis there is more time available to localise the bleeding site and determine underlying aetiology. So it would be sensible to send for CT thorax to look for cavities, masses, or vascular lesions. Thereafter bronchoscopy can be conducted to stem the bleeding. If bleeding persists bronchial artery embolisation or surgery may be required.

In an unstable patient, the situation can be challenging as the patient may exsanguinate if the bleeding site is not localised quickly. Aggressive resuscitation and notification of the relevant teams (thoracic surgery, respiratory, radiology, intensive care and haematology) is necessary. Early bronchoscopy in the intubated patient is indicated and if the bleeding site is not localised then angiography may be a useful next step.

Remember that antifungal cover alongside broad spectrum antibiotics are worth considering in cases of haemoptysis.

Answer Statistics

1

40%

2

14%

3

8%

4

27%

5

14%

Times answered: 297