Critical Care Time 14. Massive Hemoptysis
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Jan 1, 2024 Learn about the pragmatic approach to life-threatening hemoptysis. Dr. Whittney Warren discusses medications, intubation, and bronchoscopic tools. Explore the field of interventional pulmonary medicine and the immediate results it can achieve. Understand the definition of massive hemoptysis based on its life-threatening nature. Discover treatment options for stabilized bleeding including heparin nib, bronchoscope airway clearance, and cryo probes. Explore the effectiveness of cold saline, epinephrine, and tranexamic acid in managing bleeding. The hosts express gratitude, seek engagement, and thank the sponsor.
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Initial Hemoptysis Management
- Correct coagulopathy and review medications for potential interactions.
- Consider TXA nebulizer, even if evidence is stronger for minor hemoptysis, as it can buy time.
TXA Nebulization Protocol
- Nebulize 500mg of TXA diluted in 5-10ml saline, similar to albuterol.
- Be mindful of potential bronchospasm or airway casting.
Airway Casting Management
- Airway casting from TXA nebs is rarely life-threatening, though it can hinder ventilator weaning.
- Cryo probes effectively remove casts, but forceps or suction can also suffice.