This document provides guidance on evaluating and managing patients presenting with hemoptysis. It defines hemoptysis and outlines its various classifications based on blood loss. Common causes are discussed, including tuberculosis, bronchial carcinoma, bronchiectasis, and lung abscesses. A systematic approach to evaluation is recommended, beginning with history, physical exam, chest imaging, and sputum/blood tests. Bronchoscopy can help localize the bleeding site but is usually best delayed until acute bleeding subsides. The goal is to determine the cause and initiate appropriate treatment while stabilizing patients experiencing massive hemorrhage.
This document discusses pulmonary bleeding (hemoptysis). It defines hemoptysis as coughing up blood from the lungs or respiratory tract. The document outlines various causes of hemoptysis including infections like tuberculosis, lung cancers, vascular abnormalities and coagulation disorders. It also describes how to differentiate true hemoptysis from false, evaluates severity, provides clues from history and examination to suggest potential diagnoses, and lists relevant diagnostic tests and treatments.
- Hemoptysis is the expectoration of blood from the respiratory tract below the level of the vocal cords. It can range from blood-streaked sputum to gross blood. It is classified as minor (<20mL/day), moderate (20-100mL/day), or massive (100-600mL/day).
- The bronchial arteries, which arise from the aorta, are responsible for 95% of hemoptysis cases as they have higher systemic pressure. The pulmonary arteries have lower pressure and carry only a small portion of cardiac output.
- Common causes of hemoptysis include tuberculosis, bronchiectasis, mycetoma, lung abscess, mitral stenosis, and
This document contains a 46-page guide to interpreting chest x-rays written by Dr. S. Aswini Kumar. It begins by describing the process and proper views for taking a chest x-ray. It then details how to analyze different anatomical structures and pathological findings visible on chest x-rays such as lung opacities, nodules, masses, effusions, pneumothorax, fibrosis, and atelectasis. The guide provides illustrations and explanations for accurately reading and diagnosing conditions from chest radiograph images.
This document provides information on empyema, including its definition, etiology, stages, symptoms, investigations, and management. Empyema is defined as infection of the pleural space resulting in pus accumulation. It is usually caused by bacteria spreading from a pneumonia or other infection. It progresses through exudative, fibrinopurulent, and organizing stages. Symptoms include fever, cough, chest pain, and shortness of breath. Diagnosis involves imaging like chest X-ray or CT scan and thoracentesis. Management includes antibiotics, chest tube drainage, fibrinolytics, VATS, and sometimes open drainage or decortication surgery. The goal is to treat infection, drain pus, and re-expand
Hemoptysis is defined as the spitting of blood from the lungs or bronchial tubes. It can be classified based on severity from mild to massive. Common causes include infections like tuberculosis, cancers, vascular abnormalities and vasculitis. Initial management focuses on airway protection, oxygenation and circulation. Bronchoscopy helps identify the bleeding site and allows local measures like lavage, vasoconstrictors and tamponade. For persistent or massive bleeding, bronchial artery embolization or surgery may be needed. Precise localization through CT and arteriography guides definitive treatment.
Hemoptysis , definition, classification, causes and managementMoathAlkeaid
This document discusses hemoptysis (spitting up of blood from the lungs). It defines hemoptysis and differentiates it from other causes of bloody cough or vomiting. It classifies hemoptysis based on blood loss and discusses diffuse alveolar hemorrhage. Common causes of hemoptysis include infections like tuberculosis, lung cancers, bronchiectasis, and cardiovascular or collagen vascular diseases. Massive hemoptysis has underlying causes like bronchiectasis, tuberculosis, aspergilloma, lung cancer, and some cases have no identifiable cause.
This document provides guidance on evaluating and managing patients presenting with hemoptysis. It defines hemoptysis and outlines its various classifications based on blood loss. Common causes are discussed, including tuberculosis, bronchial carcinoma, bronchiectasis, and lung abscesses. A systematic approach to evaluation is recommended, beginning with history, physical exam, chest imaging, and sputum/blood tests. Bronchoscopy can help localize the bleeding site but is usually best delayed until acute bleeding subsides. The goal is to determine the cause and initiate appropriate treatment while stabilizing patients experiencing massive hemorrhage.
This document discusses pulmonary bleeding (hemoptysis). It defines hemoptysis as coughing up blood from the lungs or respiratory tract. The document outlines various causes of hemoptysis including infections like tuberculosis, lung cancers, vascular abnormalities and coagulation disorders. It also describes how to differentiate true hemoptysis from false, evaluates severity, provides clues from history and examination to suggest potential diagnoses, and lists relevant diagnostic tests and treatments.
- Hemoptysis is the expectoration of blood from the respiratory tract below the level of the vocal cords. It can range from blood-streaked sputum to gross blood. It is classified as minor (<20mL/day), moderate (20-100mL/day), or massive (100-600mL/day).
- The bronchial arteries, which arise from the aorta, are responsible for 95% of hemoptysis cases as they have higher systemic pressure. The pulmonary arteries have lower pressure and carry only a small portion of cardiac output.
- Common causes of hemoptysis include tuberculosis, bronchiectasis, mycetoma, lung abscess, mitral stenosis, and
This document contains a 46-page guide to interpreting chest x-rays written by Dr. S. Aswini Kumar. It begins by describing the process and proper views for taking a chest x-ray. It then details how to analyze different anatomical structures and pathological findings visible on chest x-rays such as lung opacities, nodules, masses, effusions, pneumothorax, fibrosis, and atelectasis. The guide provides illustrations and explanations for accurately reading and diagnosing conditions from chest radiograph images.
This document provides information on empyema, including its definition, etiology, stages, symptoms, investigations, and management. Empyema is defined as infection of the pleural space resulting in pus accumulation. It is usually caused by bacteria spreading from a pneumonia or other infection. It progresses through exudative, fibrinopurulent, and organizing stages. Symptoms include fever, cough, chest pain, and shortness of breath. Diagnosis involves imaging like chest X-ray or CT scan and thoracentesis. Management includes antibiotics, chest tube drainage, fibrinolytics, VATS, and sometimes open drainage or decortication surgery. The goal is to treat infection, drain pus, and re-expand
Hemoptysis is defined as the spitting of blood from the lungs or bronchial tubes. It can be classified based on severity from mild to massive. Common causes include infections like tuberculosis, cancers, vascular abnormalities and vasculitis. Initial management focuses on airway protection, oxygenation and circulation. Bronchoscopy helps identify the bleeding site and allows local measures like lavage, vasoconstrictors and tamponade. For persistent or massive bleeding, bronchial artery embolization or surgery may be needed. Precise localization through CT and arteriography guides definitive treatment.
Hemoptysis , definition, classification, causes and managementMoathAlkeaid
This document discusses hemoptysis (spitting up of blood from the lungs). It defines hemoptysis and differentiates it from other causes of bloody cough or vomiting. It classifies hemoptysis based on blood loss and discusses diffuse alveolar hemorrhage. Common causes of hemoptysis include infections like tuberculosis, lung cancers, bronchiectasis, and cardiovascular or collagen vascular diseases. Massive hemoptysis has underlying causes like bronchiectasis, tuberculosis, aspergilloma, lung cancer, and some cases have no identifiable cause.
Hemoptysis is defined as coughing up blood originating below the vocal cords. It can range from blood-streaked sputum to coughing up pure blood. The document discusses the definition, causes, differential diagnosis, diagnosis and treatment of hemoptysis. The main causes discussed are tracheobronchial diseases like bronchitis and tumors, as well as cardiovascular issues. Diagnosis involves history, examination, labs, chest imaging like CXR, CT, and procedures like bronchoscopy.
Pleural effusion occurs when there is an imbalance between the formation and absorption of fluid in the pleural space. This document outlines the classification, pathogenesis, etiologies, clinical features, diagnosis, and management of pleural effusions. Pleural effusions are classified as transudative or exudative based on the composition of the pleural fluid and the mechanism causing it. Diagnosis involves chest x-ray, ultrasound or CT scan followed by diagnostic thoracentesis of the pleural fluid. Management depends on the underlying cause but may include supportive care, antibiotics, diuretics, chest tube placement, or chemical pleurodesis.
Pulmonary embolism occurs when a blood clot forms, typically in the leg veins, breaks off and travels to the lungs where it lodges in the pulmonary arteries. Risk factors include prolonged bed rest, cancer, smoking and certain genetic conditions. Symptoms include chest pain, difficulty breathing, cough and rapid heart rate. Diagnosis involves tests like CT scans, lung scans, blood tests and ultrasound. Treatment focuses on thinning the blood with anticoagulant drugs like heparin and warfarin to prevent further clots, as well as oxygen and monitoring vital signs.
This document discusses respiratory failure, including its causes, types, and management. Respiratory failure occurs when inadequate gas exchange prevents normal oxygen and carbon dioxide levels in the blood. It can result from conditions affecting breathing muscles/nerves or lung tissue damage. The two main types are hypoxemic respiratory failure, where oxygen levels are too low, and hypercapnic respiratory failure, where carbon dioxide levels are too high. Management involves oxygen therapy, positioning, clearing secretions, and potentially positive pressure ventilation.
The document discusses pneumothorax, including its definition, pathophysiology, etiology, clinical manifestations, investigations, and management. Pneumothorax is defined as the presence of air in the pleural space. It can occur spontaneously due to ruptured blebs or bullae, or due to trauma. Clinical manifestations include dyspnea, chest pain, and decreased breath sounds on examination. Chest x-ray and CT scan are used to diagnose and characterize pneumothorax. Management involves oxygen therapy, needle aspiration, chest tube drainage, and chemical pleurodesis to promote lung re-expansion and prevent recurrence.
This document provides an overview of hemoptysis, including:
1. Defining hemoptysis as the spitting of blood originating in the lungs or bronchial tubes and discussing massive hemoptysis.
2. Outlining the pathophysiology, etiologies, risk factors, clinical presentation, diagnostic measures, and management of hemoptysis.
3. Stating the learning objectives are for students to understand hemoptysis, be able to recognize it, discuss its pathophysiology and causes, compare it to hematemesis, recognize its clinical presentation, identify diagnostic measures, and outline its management.
Hemoptysis is defined as coughing up blood originating from below the vocal cords. It can range from mild blood streaking to over 600ml of blood loss in 24 hours (massive hemoptysis). The causes of hemoptysis are numerous but the most common causes of massive hemoptysis are active tuberculosis, bronchiectasis, mycetoma, and bronchogenic carcinoma. The initial evaluation of a patient with hemoptysis involves obtaining a detailed history, physical exam, and basic laboratory tests to determine the severity and potential causes. Further diagnostic tests may then be used to confirm the diagnosis.
Hemoptysis refers to coughing up blood from the respiratory tract. It can range from a small amount of blood-tinged mucus to life-threatening massive hemorrhage. Common causes include infections, lung cancer, and vascular conditions. Evaluation involves assessing the type and amount of bleeding along with diagnostic tests like chest imaging, sputum analysis, and bronchoscopy. Treatment focuses on stabilizing the patient, stopping the bleeding, and addressing the underlying cause through techniques such as bronchial artery embolization, surgery, or medications. Complications can include asphyxiation, shock, and infection if not properly managed.
- ARDS is an acute respiratory condition characterized by diffuse lung inflammation and fluid buildup in the lungs, causing hypoxemia. Common causes include sepsis, aspiration, and pneumonia.
- The document discusses the definition, pathogenesis, clinical presentation, diagnosis, and management of ARDS. The primary goals of management are treating the underlying cause, maintaining oxygenation levels through ventilation strategies like low tidal volumes, and preventing further lung injury.
- Low tidal volume ventilation, which aims to limit overexpansion of alveoli, is the best proven strategy to improve survival based on current evidence. Other adjuncts like prone positioning and PEEP may also help optimize oxygenation in some cases.
This document discusses various types and causes of hemothorax. It defines hemothorax as blood in the pleural space and lists trauma, medical conditions, and iatrogenic causes. Treatment options discussed include tube thoracostomy for drainage, VATS for bleeding control, and CT-guided arterial embolization. Complications like clot retention, empyema, and fibrothorax are described. Nontraumatic causes such as malignancy, anticoagulation therapy, and endometriosis are also summarized.
Pneumothorax refers to the presence of air in the pleural space and can occur spontaneously due to ruptured blebs or as a result of trauma or medical procedures. It presents clinically as reduced breath sounds, hyperresonance to percussion, and mediastinal shift. Chest x-ray or CT scan are used for diagnosis and show hypertranslucency. Treatment involves supplemental oxygen, aspiration, or chest tube placement. Physiotherapy focuses on improving ventilation and exercise tolerance. Recurrence can be prevented through procedures like pleurodesis or thoracotomy along with smoking cessation.
Apparently a lengthy presentation actually very good for junior physicians as it covers all aspects of assessment, diagnosis and treatment of pleural effusion
This document provides an overview of diseases of the pleura, including pleurisy, pleural effusion, empyema, pneumothorax, and mesothelioma. It discusses the anatomy and physiology of the pleura, causes and characteristics of pleural diseases, and how they are investigated and managed. Key points include that pleurisy is inflammation of the pleura causing chest pain, pleural effusion is abnormal fluid accumulation in the pleural space, and the fluid can be transudative or exudative depending on the underlying cause such as heart failure or infection/malignancy respectively.
Haemoptysis, or coughing up blood from the lungs or respiratory tract, can have various causes including infections like tuberculosis, lung cancer, or other chronic lung conditions. The document describes 4 cases of haemoptysis, including a 23-year-old male with a history of TB, a 70-year-old male smoker evaluated for sudden hemoptysis, a 21-year-old male with massive hemoptysis and HIV, and an 80-year-old male referred for dental bleeding workup. Causes, risk factors, presentations, signs, and mechanisms of massive haemoptysis are also outlined.
1. Hypoxemia, defined as low oxygen levels in arterial blood, can be caused by hypoventilation, low inspired oxygen, right-to-left shunts, ventilation-perfusion mismatching, or diffusion impairment in the lungs.
2. Physical exam and arterial blood gas analysis are used to diagnose hypoxemia and its underlying causes. Treatment focuses on oxygen supplementation, treating the underlying condition, correcting acid-base imbalances, and mechanical ventilation if needed.
3. The causes, mechanisms, diagnosis and management of hypoxemia are complex but critical for treatment of respiratory failure.
This document discusses the approach to bullous lung disease. It defines a bulla as a large air-containing space within the lung larger than 1 cm in diameter. Bullae can occur with emphysema, pulmonary fibrosis, or in otherwise normal lungs. HRCT is useful for evaluating the size, number and relationships of bullae. Pulmonary function testing may show obstructive lung disease, hyperinflation and reduced diffusion capacity. For surgical candidates, bullectomy or lung volume reduction surgery may be considered to treat symptoms or complications like spontaneous pneumothorax.
This document discusses acute respiratory distress syndrome (ARDS). It begins with definitions of ARDS and related conditions. It then covers signs and symptoms, causes, pathophysiology involving ventilation-perfusion mismatching and reduced lung compliance. Monitoring involves blood gases and oxygenation assessments. Management focuses on oxygen supplementation, ventilation support ranging from non-invasive to invasive modes, and mechanical ventilation strategies to protect the lungs while ensuring adequate gas exchange.
Pleural effusion results from an imbalance between pleural fluid formation and absorption, causing fluid to accumulate in the pleural space. Fluid formation occurs through capillaries in the parietal pleura, and absorption occurs via lymphatic vessels. When the rate of formation exceeds absorption, effusion occurs. Effusions are classified as transudative or exudative based on fluid characteristics. Diagnostic testing of pleural fluid aims to determine the cause of effusion. Radiography and ultrasound are used to identify and characterize pleural fluid.
This document provides information about pleural effusions. It defines a pleural effusion as excess fluid buildup between the pleural layers outside the lungs. Normally a small amount of fluid is present and circulated, but over 25mL is considered an effusion. Effusions are classified as transudative or exudative based on their characteristics. Symptoms include chest pain and breathing difficulties. Diagnosis involves physical exam, imaging like x-rays, and fluid analysis. Management depends on the underlying cause but may include drainage, medication, or surgery in severe cases.
This document provides an overview of pleural effusion findings on chest x-rays. It defines the pleural space and reasons fluid may accumulate there. Key signs of pleural effusion on chest x-ray include a blunted costophrenic angle, meniscus sign, and elevated hemidiaphragm. Loculated effusions can form adhesions and appear as smooth, poorly defined masses that droop on upright images. Different views and positions are useful to detect various amounts of pleural fluid.
A pleural effusion occurs when excess fluid accumulates in the pleural cavity, resulting in impaired breathing. Various types of pleural effusions exist depending on the fluid composition and cause. Common causes include heart failure, cirrhosis, infections, tumors, and trauma. Diagnosis involves physical exam, chest x-ray, ultrasound, and diagnostic thoracentesis. Treatment depends on the underlying cause but may include antibiotics, diuretics, thoracentesis, chest tubes, pleurodesis, or indwelling catheters. Complications can include lung scarring, pneumothorax, empyema, and sepsis.
Pulmonary bleeding (hemoptysis) is defined as coughing up blood originating from below the vocal cords. The document discusses the causes, diagnosis, and treatment of hemoptysis. Regarding diagnosis, important factors to address in history, clinical examination findings, laboratory investigations like sputum analysis and chest X-ray are discussed which can help identify underlying conditions and guide treatment. The differential diagnosis includes infections like tuberculosis, lung cancers, bronchiectasis among others. Immediate treatment includes oxygen supplementation, tracheal suctioning, and treating any underlying coagulation abnormalities.
Hemoptysis is defined as coughing up blood originating below the vocal cords. It can range from blood-streaked sputum to coughing up pure blood. The document discusses the definition, causes, differential diagnosis, diagnosis and treatment of hemoptysis. The main causes discussed are tracheobronchial diseases like bronchitis and tumors, as well as cardiovascular issues. Diagnosis involves history, examination, labs, chest imaging like CXR, CT, and procedures like bronchoscopy.
Pleural effusion occurs when there is an imbalance between the formation and absorption of fluid in the pleural space. This document outlines the classification, pathogenesis, etiologies, clinical features, diagnosis, and management of pleural effusions. Pleural effusions are classified as transudative or exudative based on the composition of the pleural fluid and the mechanism causing it. Diagnosis involves chest x-ray, ultrasound or CT scan followed by diagnostic thoracentesis of the pleural fluid. Management depends on the underlying cause but may include supportive care, antibiotics, diuretics, chest tube placement, or chemical pleurodesis.
Pulmonary embolism occurs when a blood clot forms, typically in the leg veins, breaks off and travels to the lungs where it lodges in the pulmonary arteries. Risk factors include prolonged bed rest, cancer, smoking and certain genetic conditions. Symptoms include chest pain, difficulty breathing, cough and rapid heart rate. Diagnosis involves tests like CT scans, lung scans, blood tests and ultrasound. Treatment focuses on thinning the blood with anticoagulant drugs like heparin and warfarin to prevent further clots, as well as oxygen and monitoring vital signs.
This document discusses respiratory failure, including its causes, types, and management. Respiratory failure occurs when inadequate gas exchange prevents normal oxygen and carbon dioxide levels in the blood. It can result from conditions affecting breathing muscles/nerves or lung tissue damage. The two main types are hypoxemic respiratory failure, where oxygen levels are too low, and hypercapnic respiratory failure, where carbon dioxide levels are too high. Management involves oxygen therapy, positioning, clearing secretions, and potentially positive pressure ventilation.
The document discusses pneumothorax, including its definition, pathophysiology, etiology, clinical manifestations, investigations, and management. Pneumothorax is defined as the presence of air in the pleural space. It can occur spontaneously due to ruptured blebs or bullae, or due to trauma. Clinical manifestations include dyspnea, chest pain, and decreased breath sounds on examination. Chest x-ray and CT scan are used to diagnose and characterize pneumothorax. Management involves oxygen therapy, needle aspiration, chest tube drainage, and chemical pleurodesis to promote lung re-expansion and prevent recurrence.
This document provides an overview of hemoptysis, including:
1. Defining hemoptysis as the spitting of blood originating in the lungs or bronchial tubes and discussing massive hemoptysis.
2. Outlining the pathophysiology, etiologies, risk factors, clinical presentation, diagnostic measures, and management of hemoptysis.
3. Stating the learning objectives are for students to understand hemoptysis, be able to recognize it, discuss its pathophysiology and causes, compare it to hematemesis, recognize its clinical presentation, identify diagnostic measures, and outline its management.
Hemoptysis is defined as coughing up blood originating from below the vocal cords. It can range from mild blood streaking to over 600ml of blood loss in 24 hours (massive hemoptysis). The causes of hemoptysis are numerous but the most common causes of massive hemoptysis are active tuberculosis, bronchiectasis, mycetoma, and bronchogenic carcinoma. The initial evaluation of a patient with hemoptysis involves obtaining a detailed history, physical exam, and basic laboratory tests to determine the severity and potential causes. Further diagnostic tests may then be used to confirm the diagnosis.
Hemoptysis refers to coughing up blood from the respiratory tract. It can range from a small amount of blood-tinged mucus to life-threatening massive hemorrhage. Common causes include infections, lung cancer, and vascular conditions. Evaluation involves assessing the type and amount of bleeding along with diagnostic tests like chest imaging, sputum analysis, and bronchoscopy. Treatment focuses on stabilizing the patient, stopping the bleeding, and addressing the underlying cause through techniques such as bronchial artery embolization, surgery, or medications. Complications can include asphyxiation, shock, and infection if not properly managed.
- ARDS is an acute respiratory condition characterized by diffuse lung inflammation and fluid buildup in the lungs, causing hypoxemia. Common causes include sepsis, aspiration, and pneumonia.
- The document discusses the definition, pathogenesis, clinical presentation, diagnosis, and management of ARDS. The primary goals of management are treating the underlying cause, maintaining oxygenation levels through ventilation strategies like low tidal volumes, and preventing further lung injury.
- Low tidal volume ventilation, which aims to limit overexpansion of alveoli, is the best proven strategy to improve survival based on current evidence. Other adjuncts like prone positioning and PEEP may also help optimize oxygenation in some cases.
This document discusses various types and causes of hemothorax. It defines hemothorax as blood in the pleural space and lists trauma, medical conditions, and iatrogenic causes. Treatment options discussed include tube thoracostomy for drainage, VATS for bleeding control, and CT-guided arterial embolization. Complications like clot retention, empyema, and fibrothorax are described. Nontraumatic causes such as malignancy, anticoagulation therapy, and endometriosis are also summarized.
Pneumothorax refers to the presence of air in the pleural space and can occur spontaneously due to ruptured blebs or as a result of trauma or medical procedures. It presents clinically as reduced breath sounds, hyperresonance to percussion, and mediastinal shift. Chest x-ray or CT scan are used for diagnosis and show hypertranslucency. Treatment involves supplemental oxygen, aspiration, or chest tube placement. Physiotherapy focuses on improving ventilation and exercise tolerance. Recurrence can be prevented through procedures like pleurodesis or thoracotomy along with smoking cessation.
Apparently a lengthy presentation actually very good for junior physicians as it covers all aspects of assessment, diagnosis and treatment of pleural effusion
This document provides an overview of diseases of the pleura, including pleurisy, pleural effusion, empyema, pneumothorax, and mesothelioma. It discusses the anatomy and physiology of the pleura, causes and characteristics of pleural diseases, and how they are investigated and managed. Key points include that pleurisy is inflammation of the pleura causing chest pain, pleural effusion is abnormal fluid accumulation in the pleural space, and the fluid can be transudative or exudative depending on the underlying cause such as heart failure or infection/malignancy respectively.
Haemoptysis, or coughing up blood from the lungs or respiratory tract, can have various causes including infections like tuberculosis, lung cancer, or other chronic lung conditions. The document describes 4 cases of haemoptysis, including a 23-year-old male with a history of TB, a 70-year-old male smoker evaluated for sudden hemoptysis, a 21-year-old male with massive hemoptysis and HIV, and an 80-year-old male referred for dental bleeding workup. Causes, risk factors, presentations, signs, and mechanisms of massive haemoptysis are also outlined.
1. Hypoxemia, defined as low oxygen levels in arterial blood, can be caused by hypoventilation, low inspired oxygen, right-to-left shunts, ventilation-perfusion mismatching, or diffusion impairment in the lungs.
2. Physical exam and arterial blood gas analysis are used to diagnose hypoxemia and its underlying causes. Treatment focuses on oxygen supplementation, treating the underlying condition, correcting acid-base imbalances, and mechanical ventilation if needed.
3. The causes, mechanisms, diagnosis and management of hypoxemia are complex but critical for treatment of respiratory failure.
This document discusses the approach to bullous lung disease. It defines a bulla as a large air-containing space within the lung larger than 1 cm in diameter. Bullae can occur with emphysema, pulmonary fibrosis, or in otherwise normal lungs. HRCT is useful for evaluating the size, number and relationships of bullae. Pulmonary function testing may show obstructive lung disease, hyperinflation and reduced diffusion capacity. For surgical candidates, bullectomy or lung volume reduction surgery may be considered to treat symptoms or complications like spontaneous pneumothorax.
This document discusses acute respiratory distress syndrome (ARDS). It begins with definitions of ARDS and related conditions. It then covers signs and symptoms, causes, pathophysiology involving ventilation-perfusion mismatching and reduced lung compliance. Monitoring involves blood gases and oxygenation assessments. Management focuses on oxygen supplementation, ventilation support ranging from non-invasive to invasive modes, and mechanical ventilation strategies to protect the lungs while ensuring adequate gas exchange.
Pleural effusion results from an imbalance between pleural fluid formation and absorption, causing fluid to accumulate in the pleural space. Fluid formation occurs through capillaries in the parietal pleura, and absorption occurs via lymphatic vessels. When the rate of formation exceeds absorption, effusion occurs. Effusions are classified as transudative or exudative based on fluid characteristics. Diagnostic testing of pleural fluid aims to determine the cause of effusion. Radiography and ultrasound are used to identify and characterize pleural fluid.
This document provides information about pleural effusions. It defines a pleural effusion as excess fluid buildup between the pleural layers outside the lungs. Normally a small amount of fluid is present and circulated, but over 25mL is considered an effusion. Effusions are classified as transudative or exudative based on their characteristics. Symptoms include chest pain and breathing difficulties. Diagnosis involves physical exam, imaging like x-rays, and fluid analysis. Management depends on the underlying cause but may include drainage, medication, or surgery in severe cases.
This document provides an overview of pleural effusion findings on chest x-rays. It defines the pleural space and reasons fluid may accumulate there. Key signs of pleural effusion on chest x-ray include a blunted costophrenic angle, meniscus sign, and elevated hemidiaphragm. Loculated effusions can form adhesions and appear as smooth, poorly defined masses that droop on upright images. Different views and positions are useful to detect various amounts of pleural fluid.
A pleural effusion occurs when excess fluid accumulates in the pleural cavity, resulting in impaired breathing. Various types of pleural effusions exist depending on the fluid composition and cause. Common causes include heart failure, cirrhosis, infections, tumors, and trauma. Diagnosis involves physical exam, chest x-ray, ultrasound, and diagnostic thoracentesis. Treatment depends on the underlying cause but may include antibiotics, diuretics, thoracentesis, chest tubes, pleurodesis, or indwelling catheters. Complications can include lung scarring, pneumothorax, empyema, and sepsis.
Pulmonary bleeding (hemoptysis) is defined as coughing up blood originating from below the vocal cords. The document discusses the causes, diagnosis, and treatment of hemoptysis. Regarding diagnosis, important factors to address in history, clinical examination findings, laboratory investigations like sputum analysis and chest X-ray are discussed which can help identify underlying conditions and guide treatment. The differential diagnosis includes infections like tuberculosis, lung cancers, bronchiectasis among others. Immediate treatment includes oxygen supplementation, tracheal suctioning, and treating any underlying coagulation abnormalities.
This document discusses pulmonary embolism (PE), which occurs when a blood clot forms in the lungs. It defines PE, lists risk factors like immobilization and oral contraceptive use, and describes the two main types - thrombotic and non-thrombotic. Signs and symptoms include dyspnea, tachypnea, and hypoxemia. Diagnostic tests include D-dimer, CT scans, ventilation-perfusion scans, and angiograms. Treatment involves anticoagulants like heparin and warfarin to prevent further clotting. Nursing care focuses on monitoring for complications, managing pain and anxiety, and educating patients about anticoagulant therapy and risk reduction.
This document provides information on upper gastrointestinal bleeding (UGIB), including its definition, epidemiology, causes, clinical presentation, diagnostic evaluation, and management. Some key points:
- UGIB is 5 times more common than lower GI bleeding and is most often caused by peptic ulcers (duodenal more than gastric).
- Clinical presentation depends on the rate of bleeding, ranging from chronic anemia to hypovolemic shock.
- Initial management involves resuscitation, blood transfusion, and early endoscopy for diagnosis and treatment.
- Endoscopy allows for diagnosis in 80% of cases and treatment of high-risk stigmata like active bleeding or non-bleeding visible
This document provides an overview of pleural effusions, including:
1. Definitions of pleural effusion and normal pleural fluid composition.
2. Causes and characteristics of transudative and exudative effusions. Transudative effusions are caused by systemic processes while exudative effusions are caused by local processes like infection or cancer.
3. Diagnostic tools for pleural effusions including thoracentesis, imaging modalities like ultrasound, chest x-ray, and CT scan. Thoracentesis allows examination of pleural fluid.
The document discusses cough and its potential causes. Cough can be initiated by airway irritants, inflammation, or compression/constriction of the airways. Common causes of cough include infections, asthma, tumors, granulomas, congestive heart failure, and use of ACE inhibitors. The cough reflex involves both sensory afferent pathways and motor efferent pathways. Evaluation of cough involves considering its chronicity, associated symptoms, seasonality, relationship to postnasal drip or reflux, presence of fever or sputum, and underlying diseases or risk factors of the patient. Diagnostic tests may include imaging, pulmonary function tests, and sputum examination.
This document defines cough and hemoptysis (coughing up blood) and discusses their causes and characteristics. It provides two definitions of cough from the European Respiratory Society. Cough is initiated by receptors in the airways and involves a rapid inspiration followed by forced expiration and expulsion of air. Hemoptysis can be life-threatening and requires prompt evaluation. Common causes of cough and hemoptysis include infections like pneumonia, conditions like bronchitis or bronchiectasis, and cancers. Medications are discussed that can treat cough through expectorant, anti-tussive, antihistamine, and bronchodilator actions.
This document discusses the approach to hemoptysis. It defines hemoptysis and massive hemoptysis. The main causes are inflammatory, neoplastic, cardiovascular, traumatic, pulmonary vasculitis and miscellaneous factors. Treatment depends on the amount of bleeding, with minor hemoptysis often resolving on its own and massive hemoptysis requiring stabilization, protection of the non-bleeding lung, endobronchial tamponade, bronchial arterial embolization, and sometimes surgery.
This document discusses cough and hemoptysis (coughing up blood). It defines cough as a protective mechanism to clear the airways and hemoptysis as blood coming from the respiratory tract. It covers the mechanisms, common causes, approaches to evaluation, and treatment options for cough and hemoptysis. The document is brought to you by an organization called Other Mother that aims to improve healthcare access in India.
The document discusses pleural effusions, including:
1. The anatomy and mechanisms of pleural fluid turnover, with fluid entering and leaving the pleural space through membranes.
2. The etiology and pathogenesis of pleural effusions, which can result from elevated pressures, inflammation, or decreased oncotic pressure.
3. Approaches to evaluating patients with pleural effusions, including diagnostic thoracentesis to classify effusions and determine the disease cause.
This document summarizes pleural effusions, including their anatomy, mechanisms, etiologies, clinical presentations, diagnostic approaches, and management strategies. Pleural effusions can be caused by conditions that elevate pleural pressures or permeability. A diagnostic thoracentesis is usually needed to determine if an effusion is a transudate or exudate and identify the underlying cause. Management depends on the etiology but may include antibiotics, drainage, or anti-tuberculosis therapy.
1. The document discusses respiratory diseases, focusing on pleural effusions and pneumothorax.
2. For pleural effusions, it describes etiology, pathogenesis, symptoms, diagnostic tests including thoracentesis, and treatment approaches. Transudative and exudative effusions are distinguished.
3. Pneumothorax is defined as gas accumulation in the pleural cavity. Causes include spontaneous rupture of alveoli or chest wall injury. Classification includes spontaneous, traumatic, and nosocomial pneumothorax.
The document discusses hemoptysis (coughing up blood from the lungs). It defines hemoptysis and outlines several learning objectives related to understanding the condition. Key points include:
- Hemoptysis is defined as spitting up blood originating from the lungs or bronchial tubes. Massive hemoptysis refers to coughing up over 100mL-1000mL of blood in 24 hours.
- Causes can include infections like tuberculosis, lung cancers, injuries or disorders affecting blood vessels in the lungs. Diagnostic tests include imaging like chest x-rays and CT scans, as well as sputum cultures and bronchoscopy.
- Treatment depends on the severity but may include medications to stop
A 65-year-old male smoker presented with left-sided chest pain and difficulty breathing for 2 weeks and was found to have a left pleural effusion secondary to tuberculosis based on symptoms, examination findings showing dullness and absent breath sounds on the left side, and imaging showing pleural effusion on the left.
This document discusses haemoptysis (expectoration of blood from the lungs or respiratory tract below the larynx). It notes that haemoptysis is a common symptom seen in 7-15% of chest clinic visits. The document outlines the causes, pathophysiology, clinical presentation, diagnostic workup and classification of haemoptysis. It distinguishes between mild, moderate and massive haemoptysis and discusses different treatment approaches depending on the severity, with a focus on management of massive haemoptysis, which is a medical emergency.
The document discusses pleural effusions, including their anatomy, mechanisms, causes, clinical presentation, diagnosis and management. Specifically, it describes how pleural fluid is formed and absorbed, common causes of transudative and exudative effusions, approaches to evaluating pleural fluid, and treatments for different types of effusions such as those caused by parapneumonic infections, tuberculosis or malignancy.
A pulmonary embolism occurs when a blood clot lodges in the pulmonary artery of the lungs, blocking blood flow. Risk factors include surgery, prolonged immobility, smoking, pregnancy, and oral contraceptive use. Symptoms range from mild to severe and include difficulty breathing, chest pain, and leg swelling. Diagnosis involves tests like chest imaging, blood gas analysis, pulmonary angiography, and lung scanning. Treatment depends on severity but may include blood thinners, clot removal procedures, or thrombolytic drugs to dissolve clots. Complications can include heart failure, recurrent clots, or bleeding from blood thinners.
Acute pulmonary embolism and its management.Puja Gupta
Critical Care Nursing (CCN).Respiratory disorders. Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).
This document discusses pleurisy, which is an inflammation of the pleura (the membranes surrounding the lungs). It describes the normal physiology of the lungs and pleura. Pleurisy occurs when there is an excessive collection of fluid between the pleural layers, known as a pleural effusion, which can impair breathing. Pleural effusions are classified as transudative or exudative based on their characteristics. The document outlines various syndromes associated with pleurisy and methods for diagnosing the condition, including radiological scans. Treatment aims to remove fluid and treat the underlying cause, and may include thoracentesis or antibiotics depending on the cause of the effusion.
This document provides information on pleural effusions including the physiology of normal lungs, definition of pleural effusion, types of effusions, causes, pathophysiology, clinical manifestations, diagnostic evaluations, treatment, nursing diagnosis and interventions, and possible complications. A pleural effusion is an abnormal collection of fluid in the pleural space between the lungs and chest wall. Effusions can be transudative or exudative depending on the fluid characteristics and underlying cause. Diagnosis involves imaging and fluid analysis. Treatment focuses on removing fluid and treating the underlying cause. Nursing care centers around pain management, breathing exercises, and preventing infections.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
2. Defining CoughDefining Cough
Two possible definitions of cough as per European Respiratory Society :
A three-phase expulsive motor act characterized by an inspiratory effort
(inspiratory phase) followed by a forced expiratory effort against a closed
glottis (compressive phase) and then by opening of the glottis and rapid
expiratory airflow (expulsive phase)’.
Cough is a forced expulsive maneuver, usually against a closed glottis and
which is associated with a characteristic sound.
4. Mechanism of CoughMechanism of Cough
The cough begins with a rapid inspiration, followed, in rapid
sequence, by closure of the glottis, contraction of the
abdominal and thoracic expiratory muscles, abrupt increase
in pleural and intrapulmonary pressures, sudden opening of
the glottis, and expulsion of a burst of air from the mouth.
6. (Acute Cough)(Acute Cough)
Causes & Characteristics of CoughCauses & Characteristics of Cough
Sinusitis or NasopharygnitisSinusitis or Nasopharygnitis
Cough following an upper respiratory syndrome or sinus
symptoms; sensation of a need to clear the throat; postnasal
drip
Lobar pneumoniaLobar pneumonia
Cough often preceded by symptoms of upper respiratory
infection; cough dry, painful at first; later becomes productive
7. • Most common causesMost common causes
– Common cold (viral )
– Acute bacterial sinusitis
– Pertussis
– Exacerbation of COPD
– Allergic rhinitis
– Rhinitis secondary to environmental irritants
Conti…Conti…
8. (Chronic Cough)(Chronic Cough)
Causes & Characteristics of CoughCauses & Characteristics of Cough
BronchiectasisBronchiectasis
Cough copious, foul, purulent, often since childhood; forms
layers upon standing
1.upper : bubble-like, frothy, faomy
(partly from saliva)
2.middle : thin sero-mucus liquid
3.base : pus ,necrotic tissue , cell debris
9. Tuberculosis or fungusTuberculosis or fungus
Persistent cough for weeks to months, often with blood-
tinged sputum
Interstitial fibrosis and infiltrationsInterstitial fibrosis and infiltrations
Cough nonproductive, persistent
SmokingSmoking
Cough usually persistent, most marked in morning, usually
only slightly productive unless succeeded by chronic
bronchitis
Conti…Conti…
10. Conti…Conti…
Gastroesophageal reflux (GERD)Gastroesophageal reflux (GERD)
Nonproductive cough often following meals ; may (or may not)
be accompanied by other symptoms of GERD(e.g., heartburn,
a bitter oral taste, belching)
Left ventricular failureLeft ventricular failure
Cough intensifies while supine, along with aggravation of
dyspnea
11. Pulmonary infarctionPulmonary infarction
Cough associated with hemoptysis, usually with pleural
effusion
Angiotensin-converting enzyme (ACE) inhibitorsAngiotensin-converting enzyme (ACE) inhibitors
Nonproductive cough, more common in women, may occur
at any time (following soon after drug initiation or with
years of use)
Conti…Conti…
12. Treatment of CoughTreatment of Cough
Cough is useful physiological mechanism that serves to clear
the respiratory passages of foreign material and excess
secretions
– It should not be suppressed indiscriminately
There are however, many situations in which cough does not
serve any useful purpose
– Instead it only annoys the patient or prevents rest and sleep
15. HemoptysisHemoptysis
Hemoptysis is defined as coughing of blood originating from
below the vocal cords.
The word "hemoptysis" comes from the Greek "haima"
meaning "blood“ & "ptysis" which means "a spitting".
Hemoptysis can range from blood-streaking of sputum to the
presence of gross blood in the absence of any accompanying
sputum.
16. Life threatening (or) Massive hemoptysis is defined as
coughing of blood > 150 ml/time (or) > 600 ml/24 hours.
Only 5% of hemoptysis is massive but mortality is 80%.
Conti…Conti…
17. True Hemoptysis VersusTrue Hemoptysis Versus
Spurious (False) HemoptysisSpurious (False) Hemoptysis
True hemoptysisTrue hemoptysis False hemoptysisFalse hemoptysis
Below vocal cords Above vocal cords
Persists as blood tinged sputum Sputum is free of blood
Blood may be mixed with sputum Not mixed with sputum
History of cardiopulmonary disease Obvious by ENT examination
CXR may be abnormal Normal CXR
18. Hemoptysis VersusHemoptysis Versus
HematemesisHematemesis
HemoptysisHemoptysis HematemesisHematemesis
Coughing of bloodCoughing of blood Vomiting of bloodVomiting of blood
History of cardiopulmonary diseaseHistory of cardiopulmonary disease History of GIT diseaseHistory of GIT disease
Blood bright red in colorBlood bright red in color Dark brown in colorDark brown in color
Sputum remains blood stained after theSputum remains blood stained after the
attack for few daysattack for few days
Usually followed by melenaUsually followed by melena
Mixed with sputumMixed with sputum Mixed with gastric contentsMixed with gastric contents
Blood is frothyBlood is frothy AirlessAirless
AlkalineAlkaline AcidicAcidic
Sputum contains hemosedrin ladenSputum contains hemosedrin laden
macrophagesmacrophages
NoNo
24. Evaluation for HemoptysisEvaluation for Hemoptysis
History, Physical Examination, Chest Radiograph
CBC (Degree of anemia which may influence rapidity of
further testing & transfusion of blood products,
thrombocytopenia may be a contributing factor)
Measurement of Coagulation Times
Renal function and Urinalysis (when a systemic process which
causes pulmonary-renal syndrome is a possibility)
25. Depending on circumstances Sputum Culture & Stains or
Cytologic examination should be performed.
A high-resolution computed tomography (HRCT) of the
chest is usually the next step if the patient has no history of
tobacco use or if the plain chest radiograph suggests a
parenchymal abnormality, such as bronchiectasis or
arteriovenous malformation.
Patients with a history of tobacco use or other risk factors for
a malignancy warrant fiber optic bronchoscopy
Conti…Conti…
26. Clinical Approach for ManagementClinical Approach for Management
of Hemoptysisof Hemoptysis
Make sure that this is True Hemoptysis.
Identify the Severity of hemoptysis.
Clinical clues in History & Examination.
Diagnostic Investigations.
Appropriate Treatment.
27. Management of HemoptysisManagement of Hemoptysis
GoalGoal
1.Evaluate the severity of hemoptysis.
2.Airway protection & patency.
3.Identify the site of bleeding.
4.Protect the contralateral un involved lung.
5.Stop the bleeding.
6.Treatment of the cause of bleeding.
28. Management of Minor hemoptysisManagement of Minor hemoptysis
Minor hemoptysisMinor hemoptysis
Effort should be concentrated on determining the origin of
the hemoptysis, providing specific treatment where available
and excluding serious underlying pathology.
Normal CXR, history consistent with bronchitis - oral
antibiotic, advise smoking cessation and follow-up in a few
weeks.
29. Consider chest CT scan and bronchoscopy where:
– Haemoptysis lasts longer than 2 weeks.
– There are recurrent episodes of haemoptysis.
– The volume of haemoptysis is >30 ml per day.
– The patient is a smoker and >40 years old.
– There is suspected bronchiectasis.
Conti…Conti…
30. Moderate haemoptysis
Moderate hemoptysis (30-50 ml in the previous 24 hours)
requires hospitalization for observation, due to increased risk
of further heavy bleeding.
Nurse in the semi-sitting position when awake and with
abnormal lung down when lying in bed.
Consider cough suppression with codeine but avoid over
sedation.
Await bronchoscopy - diagnostic yield is often highest when
performed a few days after bleeding has stopped.
31. Major haemoptysisMajor haemoptysis
≥500 mL of expectorated blood over a 24 hour period or
bleeding at a rate ≥100 mL/hour,
This is a medical emergency which require immediate
hospital admission
• Treatment categories into > Medical > Surgical >
Endobronchial > Endovascular
32. Management of MassiveManagement of Massive
HemoptysisHemoptysis
I. Medical
Endotracheal tube (single wide bore (or) double lumen).
Position of the patient sitting (or) bleeding side down
Large bore IV line fluids, blood transfusion .
Supplemental Oxygen/ Mechanical ventilation.
Avoid cough suppressants (if necessary Benzodiazepine).
Pitressin (Vasopressin) 0.2-0.4 units/min. IV.
Oral tranexamic acid has been used long term in recurrent bleeders with some
success. Dose is 15-25 mg/kg TDS (max 1.5 g/dose).
35. IV. Endovascular:
First results of embolization were published in 1973.
In most patients the bleeding originates from bronchial
arteries rather than pulmonary arteries.
Trans catheter embolization is effective in immediate
control of massive hemoptysis (73% - 98%).
Conti..Conti..
36. Recurrence may be caused by:
– Incomplete embolization of artery.
– Recanalization of previously embolized artery.
– Revascularization through collateral
circulation.
– Progression of basic lung disease.
Conti..Conti..
38. PrognosisPrognosis
Haemoptysis may be a mild, self-limiting symptom or may
herald serious underlying disease.
Massive haemoptysis can directly cause death and has a bad
prognosis, worse in some groups such as those with an
underlying cancer.
39. Lung CancerLung Cancer
Lung cancer has been the most common cancer in the world
for several decades.
Lung cancer usually starts in the lining of bronchi , but can
also begin in other area of respiratory system , including the
trachea , broncheoles , or alveoli.
Lung cancers are believed to develop over a periods of many
years.
40. Cancer is a leading cause of death worldwide,
accounting for 8.8 million deaths in 2015.
The most common causes of cancer death are cancers of:
Lung (1.69 million deaths)19.4% of total.
Liver (788 000 deaths)
Colorectal (774 000 deaths)
Stomach (754 000 deaths)
Breast (571 000 deaths)
42. Lung Cancer Risk Factors (2007Lung Cancer Risk Factors (2007
American Cancer Society Data)American Cancer Society Data)
Gender
Smoking history
Older age
Presence of airflow obstruction
Genetic predisposition
Occupational
exposures(Arsenic,Asbestos,Chromium,Mustard
gas,Nickel,Silica,Vinyl chloride and polycyclic aromatic
43. Lung Cancer and GenderLung Cancer and Gender
(2007 American Cancer Society Data)(2007 American Cancer Society Data)
Male predilection, but changing rapidly
Increase in women smokers
– 55% Men
– 45% Women
44. LUNG CANCERLUNG CANCER
(2007 American Cancer Society Data)(2007 American Cancer Society Data)
Tobacco Percent
Active 85-87
Passive 3-5
Etiology
Relationship to Smoking
45. Lung Cancer and SmokingLung Cancer and Smoking
(2007 American Cancer Society Data)(2007 American Cancer Society Data)
~90% of lung cancers attributed to smoking
However, only 20% smokers will develop lung cancer in their
lifetime.
Risk decreases when stop smoking
Yet, 50% of new cases are former smokers
46. DIAGNOSTIC WORKUPDIAGNOSTIC WORKUP
History: metastasis symptoms
P/E: H & N lymph nodes
Chest X-ray
CT: the most valuable radiologic study for evaluation,
staging, and therapeutic planning of lung cancer
MRI: mediastinum or paravertebral region
Bone scans: stage III before curative therapy
47. PET scan
Brain CT scan: small cell carcinoma.
Pulmonary function tests: ability to undergo surgical resection
or withstand irradiation
Conti..Conti..
49. Types of lung cancerTypes of lung cancer
Non small cell carcinoma(NSCC) 85%
– Adenocarcinoma 40%
– Squamous cell carcinoma(epidermoid)30%
– Large cell carcinoma 15%
Small cell carcinoma 15%
50. Adenocarcinoma 40%Adenocarcinoma 40%
Location: Peripheral
Characteristics: Most common lung cancer in non smokers
and overall,associated with hypertrophic
osteoarthopathy(clubbing)
CXR often shows hazzy infiltrates similar pneumonia
Prognosis is excellent
Histology:Thickening of alveolar walls
51. Squamous cell carcinoma 30%Squamous cell carcinoma 30%
location: Central
Characteristics: Hilar mass arising from bronchus; Cavitation;
Cigarettes; hyperCalcemia; This type of lung cancer most
often stays within the lung, spreads to lymph nodes, and
grows quite large, forming a cavity
Histology: Keratin pearls and intracellular bridges
52. Large cell carcinoma 15%Large cell carcinoma 15%
Location: peripheral
Characteristics: Highly anaplastic, This type of cancer has a
high tendency to spread to the lymph nodes and distant sites
Pronosis: Very poor,less responsive to chemotherapy
Histology: Pleomorphic giant cells
53. Small cell carcinoma 15%Small cell carcinoma 15%
Location: Central
Characteristics: Undifferentiated, very aggressive , may
produce ACTH,ADH. SCLC is strongly related to
cigarette smoking. It metastasize rapidly to many sites within
the body and are most often discovered after they have
spread extensively.
Prognosis: Inoperable,Treat with chemotherapy
Histology: Neoplasm of neuroendocrine cells
54. Other TypesOther Types
Some other types of lung cancers are
Bronchial carcinoid tumors
Mesothelioma
Pancoast tumors
55. TNM categories in lung cancerTNM categories in lung cancer
T1-T4: T1: < 3cm, surr by lung
T2: > 3cm / main bronchus /
visceral pleura
T3: any size / invades chest wall / diaph
mediast pleura / parietal pericard
T4: any size / invades
mediastinum /malignant effusion
58. .
Management: ACCP guidelines(5)Management: ACCP guidelines(5)
CT Screening
• Only to smokers age
55-74, with > 30
pack/year of smoking
• Not to pts. with
severe comorbidities
Stages I & II
• VATS with
systematic lymph
node sampling
preferred
• Better outcomes
with specialty-
trained surgeons &
at high-volume
centers
Stage III
• Chemo + radiation
therapy for most
N2,3 pts
• Trimodal approach
for toxicity mgmt.
• Tailor treatment
depending on
mediastinal
involvement
Stage IV
• EGFR+ pts: targeted
therapy (TKRIs >
Gefitinib) is 1st
line of
treatment
• Appropriate
maintenance
chemotherapy
• VEGF inhibitors safe
& useful
• Doublet
chemotherapy in
selected cases
ACCP, American College of Chest Physicians; chemo, chemotherapy; mgmt., management; NLST, National Lung Cancer Screening Trial; pts., patients;
VATS, video-assisted thoracic surgery; VEGF, Vascular endothelial growth factor.Cisplatin+carboplatin(doublet therapy)
5. Detterbeck FC, Lewis SZ, Diekemper R, Addrizzo-Harris D, Alberts WM. Executive Summary: Diagnosis and management of lung cancer, 3rd ed:
American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):7s-37s.
Advances in treatment for different stages