Pulmonary bleeding

Description:

This expiration of blood from pulmonary or bronchial vessels which is followed by release of blood from respiratory tracts.

Symptoms of Pulmonary bleeding:

Blood from respiratory tracts is usually emitted with cough. The quantity it can be various — from blood streaks in a phlegm (blood spitting) to profuse bleeding a continuous flow. In some cases the pneumorrhagia is a harbinger of plentiful bleeding from lungs. The blood emitted from respiratory tracts liquid, without clots, foamy, has alkali reaction. At patients with plentiful bleeding in lower parts of lungs it is possible to listen to mixed wet rattles.

  At plentiful bleedings patients are pale, become covered cold then, pulse becomes frequent, small and soft, arterial pressure decreases — the kollaptoidny state develops. After the termination of bleeding of the patient within several days expectorates the phlegm painted by blood.

Reasons of Pulmonary bleeding:

Pulmonary bleeding can arise at nonspecific inflammatory processes in lungs or bronchial tubes, tuberculosis and lung cancer, aneurisms, in system of pulmonary blood circulation, pulmonary endometriosis, in the presence of foreign bodys in lungs and bronchial tubes, an embolism of pulmonary arteries, fungal and parasitic diseases of lungs, wounds and injuries of a thorax, defects of the mitral valve of heart and at some other diseases. Small impurity of blood in a phlegm is defined usually in the first days after lung operations, including after a biopsy of pulmonary fabric.

  The bleeding point can be in lungs, bronchial tubes or in department of the trachea located below phonatory bands. Intensity of a pneumorrhagia can be various — from insignificant impurity of blood in a phlegm to the massive bleeding leading the patient to death in a few minutes.

  Most often bleeding comes from bronchial arteries which it is excessive are developed and aneurysmally are changed in the field of chronic inflammatory process. In case of sharply arisen destructive defeats of pulmonary fabric, and also at wounds and injuries of a thorax pulmonary arteries and veins happen a bleeding point usually. Developing of pulmonary bleeding is promoted hypertensia in a small circle of blood circulation, disturbance of coagulability of blood.

Treatment of Pulmonary bleeding:

All patients with pulmonary bleeding have to be hospitalized in pulmonary department or department of chest surgery. Possibilities of first aid at pulmonary bleeding are very limited.
  Medical actions have to be directed first of all to the prevention of obturation of bronchial tubes by clots, and at breath disturbance — to recovery of passability of respiratory tracts.
  The patient is given a sitting or semi-sitting position with an inclination towards a lung from which bleeding is supposed; in such situation danger of aspiration of blood in an opposite lung decreases. The persistent cough which is observed at pulmonary bleeding should not be suppressed completely not to interfere with expectoration of the blood which streamed in bronchial tubes and not to create conditions for developing of aspiration pneumonia.
  
  If bronchial passability is not recovered at cough, blood is sucked away through a catheter or that is more effective, via the bronchoscope. The bronchospasm accompanying obturation of bronchial tubes is stopped introduction of m cholinolytics (atropine sulfate 0,5 — 1 ml of 0,1% of solution subcutaneously) also by b-adrenomimetikov (алупент, салбутамол, беротек it is inhalation).
  
  At asphyxia the emergency intubation of a trachea, suction of blood and artificial ventilation of the lungs are shown.

  Along with the actions for the prevention of obturation of bronchial tubes and recovery of their passability carry out haemo static therapy. At pulmonary bleeding without disturbance of a hemodynamics intravenously enter inhibitors of proteases (Contrykal on 10 000 — 20 000 PIECES or Gordoxum on 100 000 PIECES) and a fibrinolysis (aminocapronic acid — to 100 ml of 5% of solution).
  For the purpose of prevention of thrombosis and embolisms treatment kokgrikaly, it is necessary to carry out by Gordoxum and aminocapronic acid under control of a tromboelastogramma and koagulogramma. At impossibility to define indicators of coagulant system of blood it is more reasonable to appoint Haemophobinum (on 2 — 3 teaspoons inside), etamsylate (on 2 — 4 ml of 12,5% of solution intravenously or intramusculary), fibrinogen (on 2 g in isotonic solution of sodium chloride intravenously). Intravenous administration of chloride or a gluconate of calcium, imposing of plaits on an extremity at pulmonary bleeding are less effective.

  The pulmonary bleeding causing posthemorrhagic anemia is the indication to a replaceable transfusion of eritrotsitny weight (transfusion of stored blood should be avoided). For elimination of the hypovolemia which arose after big blood loss administration of native plasma, Polyglucinum, reopoliglyukin or желатиноля is recommended.

  In case of bleeding from system of bronchial arteries it is reasonable to lower the ABP (if it normal or raised), supporting systolic the ABP at the level of not less than 80 — 90 mm of mercury. For this purpose enter Pentaminum on 3 ml of 5% of solution intramusculary, petrolhexonium on 0,5 — 1 ml of 2,5% of solution subcutaneously or intramusculary; intravenously kapelno under constant control of the ABP it is possible to apply арфонад.

  In the absence of haemo static effect of medicamentous methods the bronkhoskopiya during which carry out occlusion of a bronchial tube of the bleeding segment is shown. In case of inefficiency of a bronkhoskopiya bronchial arteriography with the subsequent endovascular occlusion of bronchial arteries can be executed. These ways allow to stop pulmonary bleeding at most of patients.