core clinical problems haemoptysis. mrs reddy coughed up blood what would you like to know?
TRANSCRIPT
![Page 1: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/1.jpg)
Core Clinical ProblemsCore Clinical Problems
HaemoptysisHaemoptysis
![Page 2: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/2.jpg)
Mrs Reddy coughed up Mrs Reddy coughed up bloodblood
What would you like to know?What would you like to know?
![Page 3: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/3.jpg)
HaemoptysisHaemoptysis
Source?Source? Onset?Onset? Duration?Duration? Character?Character? Amount?Amount?
![Page 4: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/4.jpg)
HaemoptysisHaemoptysis
Source?Source? Onset?Onset? Duration?Duration? Character?Character? Amount?Amount?
Nose?Nose? GI?GI?
Vomit?Vomit? ““Coffee Ground”Coffee Ground” HaematemesisHaematemesis
Dark and acidoticDark and acidoticMelaena (also Melaena (also
swallowed blood)swallowed blood)
BronchialBronchial
![Page 5: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/5.jpg)
HaemoptysisHaemoptysis
Source?Source? Onset?Onset? Duration?Duration? Character?Character? Amount?Amount?
![Page 6: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/6.jpg)
HaemoptysisHaemoptysis
Source?Source? Onset?Onset? Duration?Duration? Character?Character? Amount?Amount?
![Page 7: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/7.jpg)
HaemoptysisHaemoptysis
Source?Source? Onset?Onset? Duration?Duration? Character?Character? Amount?Amount?
FrothyFrothy OldOld RustyRusty StreaksStreaks Mixed with Mixed with
sputum?sputum? If not consider If not consider
infarction and infarction and traumatrauma
![Page 8: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/8.jpg)
HaemoptysisHaemoptysis
Source?Source? Onset?Onset? Duration?Duration? Character?Character? Amount?Amount?
MassiveMassive ≥ ≥ 500 mls in 24h500 mls in 24h AdmissionAdmission May need May need
emergency emergency treatmenttreatment
MajorMajor 200-500 mls in 24h200-500 mls in 24h Non Major <100-Non Major <100-
200 ml OP Inv200 ml OP Inv
![Page 9: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/9.jpg)
What could be causing What could be causing Mrs Reddy’s Mrs Reddy’s
haemoptysis?haemoptysis?
![Page 10: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/10.jpg)
CausesCauses
TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
![Page 11: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/11.jpg)
CausesCauses
TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
WoundsWounds Post intubationPost intubation Foreign BodyForeign Body
![Page 12: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/12.jpg)
CausesCauses
TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
PneumoniaPneumonia AbscessAbscess Acute BronchitisAcute Bronchitis TuberculosisTuberculosis BronchiectasisBronchiectasis FungiFungi
![Page 13: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/13.jpg)
CausesCauses
TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
PrimaryPrimary SecondarySecondary
LungLung BreastBreast BrainBrain ProstateProstate ColonColon OtherOther
![Page 14: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/14.jpg)
CausesCauses
TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
Pulmonary Pulmonary Embolism Embolism
VasculitisVasculitis SLESLE Wegener’sWegener’s RARA Osler-Weber-RenduOsler-Weber-Rendu
Arteriovenous Arteriovenous malformation malformation (AVM)(AVM)
![Page 15: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/15.jpg)
CausesCauses
TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
Interstitial Lung Interstitial Lung Disease (ILD)Disease (ILD)
SarcoidSarcoid HaemosiderosisHaemosiderosis Goodpasture’s Goodpasture’s
syndromesyndrome Cystic FibrosisCystic Fibrosis
![Page 16: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/16.jpg)
CausesCauses
TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
CVSCVS Pulmonary oedemaPulmonary oedema Mitral stenosisMitral stenosis Aortic aneurysmAortic aneurysm Eisenmenger’s Eisenmenger’s
SyndromeSyndrome Bleeding DiathesisBleeding Diathesis
Including Drug Including Drug inducedinduced
![Page 17: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/17.jpg)
Mrs Reddy is 42. Mrs Reddy is 42. She presents with She presents with haemoptysis, weight loss haemoptysis, weight loss of 10 kg over 2 months of 10 kg over 2 months and night sweats.and night sweats.She has never smokedShe has never smoked
![Page 18: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/18.jpg)
Her CXR shows Her CXR shows cavitation in the right cavitation in the right upper zone.upper zone.
![Page 19: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/19.jpg)
What are the possible What are the possible diagnoses?diagnoses?
1 2 3 4 5
0% 0% 0%0%0%
1.1. TumourTumour
2.2. TBTB
3.3. PneumoniaPneumonia
4.4. Mycobateria Mycobateria other than TB other than TB (MOTT)(MOTT)
5.5. Any of themAny of them
![Page 20: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/20.jpg)
What would you like to do What would you like to do next?next?
1 2 3 4 5
0% 0% 0%0%0%
1.1. Sputum MC+SSputum MC+S
2.2. Induced sputum Induced sputum x3 for AFBx3 for AFB
3.3. CT ChestCT Chest
4.4. Commence Commence AntibioticsAntibiotics
5.5. Blood CulturesBlood Cultures
![Page 21: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/21.jpg)
Sputum samples are negative for AFB. You Sputum samples are negative for AFB. You still have high index of suspicion. What still have high index of suspicion. What
next?next?
1 2 3 4 5
0% 0% 0%0%0%
1.1. Bronchial Bronchial BiopsyBiopsy
2.2. Bronchiio-Bronchiio-Alveolar Lavage Alveolar Lavage (BAL)(BAL)
3.3. CT biopsyCT biopsy
4.4. Mantoux testMantoux test
5.5. Repeat CXR in 2 Repeat CXR in 2 monthsmonths
![Page 22: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/22.jpg)
Peter is 31.Peter is 31.He is a non smoker , suffers from He is a non smoker , suffers from
heartburn and works in a job heartburn and works in a job centre.centre.
He presents with coughing up a He presents with coughing up a small cup full of fresh blood over small cup full of fresh blood over
24 hours.24 hours.He normally keeps well and his He normally keeps well and his mother has had problems with mother has had problems with
“DVT” in the past.“DVT” in the past.
![Page 23: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/23.jpg)
His CXR is normal and you His CXR is normal and you note that his RR is 24/min, note that his RR is 24/min, HR 96/min and BP 121/63.HR 96/min and BP 121/63.His pOHis pO22 on room air is 8.3 on room air is 8.3
kPa kPa
![Page 24: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/24.jpg)
You put him on oxygen and You put him on oxygen and start him on...start him on...
1 2 3 4 5
0% 0% 0%0%0%
1.1. WarfarinWarfarin
2.2. Low Molecular Low Molecular Weight HeparinWeight Heparin
3.3. AspirinAspirin
4.4. StreptokinaseStreptokinase
5.5. Traneximic acidTraneximic acid
![Page 25: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/25.jpg)
What investigation would you What investigation would you arrange?arrange?
1 2 3 4 5
0% 0% 0%0%0%
1.1. CTPACTPA
2.2. CT chestCT chest
3.3. HRCTHRCT
4.4. PFTs + DLCOPFTs + DLCO
5.5. V/Q scanV/Q scan
![Page 26: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/26.jpg)
If Peter was 30 years If Peter was 30 years older,smoked all his life older,smoked all his life and had emphysema on and had emphysema on
his CXRhis CXR
![Page 27: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/27.jpg)
Which test would you Which test would you choose?choose?
1 2 3 4 5
0% 0% 0%0%0%
1.1. CTPACTPA
2.2. CT chestCT chest
3.3. HRCTHRCT
4.4. PFTs + DLCOPFTs + DLCO
5.5. V/Q scanV/Q scan
![Page 28: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/28.jpg)
George is 73. He presents acutely with George is 73. He presents acutely with breathlessness and coughing up frothy breathlessness and coughing up frothy
pink sputum. He has been suffering from pink sputum. He has been suffering from orthopnoea, PND and ankle oedema over orthopnoea, PND and ankle oedema over
several days.several days.
![Page 29: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/29.jpg)
He has fine inspiratory crackles at the He has fine inspiratory crackles at the bases and midzones, raised jugular bases and midzones, raised jugular
venous pressure and has a heart rate of venous pressure and has a heart rate of 110110
![Page 30: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/30.jpg)
This is his ECGThis is his ECG
![Page 31: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/31.jpg)
www.med.umich.edu/lrc/baliga/case01/LBBB.html
![Page 32: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/32.jpg)
What does this show?What does this show?
1 2 3 4 5
0% 0% 0%0%0%
1.1. Normal sinus rhythmNormal sinus rhythm
2.2. Left Bundle Branch Left Bundle Branch Block (LBBB)Block (LBBB)
3.3. Right Bundle Branch Right Bundle Branch Block (RBBB)Block (RBBB)
4.4. ST elevation ST elevation myocardial infarctionmyocardial infarction
5.5. Ventricular Ventricular tachycardiatachycardia
![Page 33: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/33.jpg)
www.med.umich.edu/lrc/baliga/case01/LBBB.html
!
![Page 34: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/34.jpg)
Which of the following is Which of the following is likely to be present on his likely to be present on his
CXR?CXR?
1 2 3 4 5
0% 0% 0%0%0%
1.1. CardiomegalyCardiomegaly
2.2. Upper lobe Upper lobe venous diversionvenous diversion
3.3. Pleural effusionPleural effusion
4.4. Kerley B LinesKerley B Lines
5.5. Perhilar patchy Perhilar patchy opacification opacification (Bat’s wing)(Bat’s wing)
![Page 35: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/35.jpg)
What has caused his What has caused his deterioration?deterioration?
1 2 3 4 5
0% 0% 0%0%0%
1.1. Acute BronchitisAcute Bronchitis
2.2. Cryptogenic Cryptogenic organising organising pneumoniapneumonia
3.3. Pulmonary embolismPulmonary embolism
4.4. Acute pulmonary Acute pulmonary oedemaoedema
5.5. Aspiration Aspiration pneumoniapneumonia
![Page 36: Core Clinical Problems Haemoptysis. Mrs Reddy coughed up blood What would you like to know?](https://reader035.vdocument.in/reader035/viewer/2022081602/551405ac550346e2488b4b12/html5/thumbnails/36.jpg)
End!End!