Pulmonary hemorrhage is the secretion of blood into the lumen of the bronchi with its subsequent coughing. In addition to pulmonary hemorrhage, the so-called hemoptysis is also secreted, i.e., the release of a small amount of blood during coughing. In some cases, in the form of separate veins in sputum. The very concept of “pulmonary bleeding” implies the release of a significantly larger volume of blood (over 50 ml per day). It sometimes happens that hemoptysis is a harbinger of quite heavy pulmonary hemorrhage.
Pulmonary hemorrhage, causes and symptoms, first aid for pulmonary hemorrhage.
Hemoptysis occurs, as a rule, in people with chronic lung diseases (tuberculosis, etc.). Small blood discharge is possible after a biopsy, as well as surgical interventions in the respiratory system – in such cases this is the norm. Causes of bleeding can be ruptures of blood vessels (large or small) of the mucous membrane of the bronchi or lung tissue, as well as ruptures of aneurysms (thinned sections of the walls) of nearby larger blood vessels.
bodies in the airways. Tissue and blood vessels of the respiratory system are injured. Significantly less often, pulmonary hemorrhages are noted in hemosiderosis (a disease associated with impaired iron metabolism), as well as Goodpaster syndrome (combined damage to the lungs and kidneys).
The possibility of developing pulmonary hemorrhage with pulmonary edema, as well as heart defects and heart attacks, is not excluded, which is explained by an increase in pressure in the pulmonary circulation. The most massive (profuse) bleeding opens after a breakthrough into the lumen of the bronchi of the aortic aneurysm. Relatively rare causes of pulmonary hemorrhage include vascular diseases of the respiratory system (varicose veins) or bleeding disorders (hemorrhagic diathesis).
Initial symptoms of pulmonary hemorrhage.
The patient, as already mentioned, can expectorate the blood in pure form or with sputum as an impurity. Pulmonary hemorrhage sometimes begins with the appearance of foamy pink sputum. Pulmonary hemorrhages are divided according to the amount of blood released into:
– Small pulmonary hemorrhage, blood loss up to 100 ml / day.
– Average pulmonary hemorrhage, blood loss of 100-500 ml / day.
– Large pulmonary hemorrhage (profuse), blood loss from 500 ml / day and above.
In the presence of profuse pulmonary hemorrhage in the lower parts of the lungs when listening, wet rales of different sizes are determined. The skin of such patients is pale in color and covered with cold sweat. Their pulse is frequent, of low filling and low voltage, and arterial pressure drops sharply. Thus, there is a development of a collaptoid state due to blood loss. Even after significant bleeding has stopped, sputum can be stained with blood for several days. It should be borne in mind that the assessment of the massiveness of bleeding is always approximate, since part of the blood is able to enter the stomach.
First aid for pulmonary hemorrhage.
A patient with pulmonary hemorrhage needs urgent hospitalization, if possible – in a specialized pulmonary department. An exception is hemoptysis, when streaks of blood can be noted in the sputum of a patient for years. This is already a matter of treating chronic lung damage. The list of immediate measures available for pulmonary hemorrhage is quite limited..
The patient must be given a semi-sitting position and ensure complete peace. Excessive excitement and motor anxiety can cause increased bleeding. It is necessary to explain to the patient that coughing should not be restrained. On the contrary, blood from the respiratory tract must be actively sprinkled. Even with profuse bleeding, blood loss is less dangerous for life than blood entering other bronchi and lungs, as the result may be the development of aspiration pneumonia or suffocation.
If the bleeding is severe, it is recommended to apply a burn harness on the limbs to reduce blood loss and blood volume in the central channel. As far as possible, the introduction of freshly frozen blood plasma (intravenous drip) in an amount of 150-200 ml should be started. To stop bleeding, aminocaproic acid is also administered intravenously (up to 100 ml of a 5% solution), 5-10 ml of 10% calcium chloride solution is injected intravenously.
If the blood flow is insignificant, then an intramuscular injection of 1 ml of 1% solution of vicasol, 1 ml of 5% solution of ascorbic acid (vitamin C) is performed, and 0.02 g of rutin is given inside. With high blood pressure, it should be reduced by intravenous jet administration of 8-10 ml of a 0.5% solution of dibazole. In especially severe cases, intravenous drip of a 5% pentamine solution in a volume of up to 0.8 ml is recommended.
If bronchial patency cannot be independently restored during coughing, blood must be sucked out by means of a catheter inserted into the airways. This manipulation can be performed by ambulance personnel in the presence of suction. In a hospital, it is more efficient to do this with a bronchoscope. Bronchoscopy allows parallel pumping of blood from the bronchi and temporary plugging of the bleeding area of the bronchus.
The bronchospasm that accompanies bleeding and impaired bronchial patency is eliminated by administering M-anticholinergics – a 0.1% solution of atropine sulfate 0.5–1 ml subcutaneously and I-adrenomimetics for inhalation (orciprenaline sulfate, salbutamol, fenoterol). In case of suffocation, one should immediately resort to an emergency introduction of a breathing tube into the trachea, suction of blood and mechanical ventilation.
In a hospital, it is often necessary to apply surgical methods to eliminate pulmonary bleeding. In order to establish the cause of pulmonary hemorrhage, collect information about the patient and an X-ray examination of the respiratory system.
Based on the book “Quick help in emergency situations”.