Bleeding from the respiratory tract or lung tissue below the larynx, which is coughing out from the mouth, is called hemoptysis. When a patient has hemoptysis of 200 ml or more at one time or hemoptysis of 500 ml or more in 24 hours, it is called hemoptysis. Hemoptysis is one of the common emergencies in respiratory medicine, and if resuscitation is not timely and care measures are not appropriate, it can easily lead to death by asphyxia or hemorrhagic shock, and patients with asphyxia can die within 3-6 min, which is one of the main causes of death of patients. Therefore, timely and correct resuscitation measures and good post-resuscitation care are important links to improve the success rate of resuscitation.
Clinical manifestations of asphyxia
Early asphyxia signs: sudden reduction or termination of hemoptysis in the process of hemoptysis, along with severe chest tightness, irritability, mental panic, laryngeal blistering sound, followed by dyspnea, lip and finger end cyanosis, cold sweat, fast and thin pulse, and still clear consciousness. Late asphyxia: cyanosis of the skin, cold extremities, agitation or convulsions, sweating, confusion, incontinence, and reduced muscle tone.
First aid drugs
(1) The first choice is posterior pituitary hormone, commonly used amount of 5-10 units added to 25% GS 40ml, with 15-20min time intravenous slowly pushed. Patients with more serious conditions can be used posterior pituitary 20 units, add 5% GNS 500ml, slow static drip, for hypertension, coronary heart disease, pregnant women caution or prohibited.
(2) When posterior pituitary hormone is not appropriate, procaine can be used. The general dose of 0.25% procaine 20ml intravenous slow injection, and later to its 100ml added to 5% GS 300ml intravenous drip maintenance, side effects are facial flushing, excitement, convulsions, etc.. The latter can be relieved by intravenous injection of isopentobarbital. Occasionally, anaphylaxis is seen, which should be used after skin test, and observation should be paid when using the drug.
(3) Intravenous access can be opened before the first intramuscular injection of lithotripsy 1ku.
(4) Hemostatic min, hemostatic aromatic acid, and anlosthematic drugs can also be applied.
(5) Apply respiratory stimulants according to the condition. If the patient’s breathing is found to become slower, shallower and irregular, use kolamine 1.5-1.875mg added to 10% GS 500ml liquid intravenously to enhance ventilation.
Treatment in case of asphyxia
If signs of asphyxia are found, the patient should be immediately placed in a lateral head-low-foot-high position and patted on the back; if the patient cannot be relieved, immediately drain the patient in a postural position, pick up the patient’s lower body upside down, adopt a prone position with head-low-foot-high 45°, or make the patient’s upper body drape over the side of the bed, another person lift the patient’s head, make the back flexed, dig out the blood clot in the mouth and pat the back to facilitate the flow of blood clot in the trachea to encourage awake patients to spit out the clot. Encourage the conscious patient to spit out the clot. If the patient is confused and the teeth are closed, use an opener to open and remove the denture, drag the tongue out, and remove the oral and pharyngeal blood clots by hand or suction in a timely manner. If postural drainage is ineffective, use suction to suck the blood clot, tracheal intubation or tracheotomy to keep the airway unobstructed.
Resuscitation cooperation
After arriving at the scene, medical personnel should divide the work clearly and collaborate with each other, and immediately start to lift the airway obstruction; at the same time, quickly choose two channels mainly in the veins of the upper limbs, one of which should be given static doses of the above-mentioned hemostatic drugs, and the other should be given supplementary blood volume fluids and resuscitation drugs; if there is difficulty in establishing the channel, first inject intramuscular hemostatic drugs.
Spiritual comfort
Do a good job in the patient’s mind, tell the patient not to be nervous and anxious, eliminate the fear, and give appropriate explanations. By giving spiritual encouragement to the patient, strengthen his confidence in overcoming the disease, so as to avoid hemoptysis caused by accelerated blood flow in the lungs due to emotional fluctuations.
Post-resuscitation care
(1) Position: Generally take the affected side to avoid blood flow to the healthy side and maintain the respiratory function of the opposite side, especially for those with one lung destroyed or with extensive pleural thickening, avoid supine, semi-recumbent and sitting positions as much as possible to avoid too much head tilting forward.
(2) Instruct the patient to cough lightly to clear the accumulated blood and keep the airway open. For patients with mixed lung infection, respiratory insufficiency and those who are old and weak and have weak cough, immediate suction and back patting are needed to assist in removing foreign bodies from the airway.
(3) Inhale oxygen at high flow rate, 4-6L/ min. clean nostrils at any time, alternate between the two nostrils, and replace the nasal catheter in time to prevent clotting from blocking the catheter and affecting the effect of oxygen therapy.
(4) Closely monitor the changes of vital signs. Pay attention to the efficacy and side effects of the medication, and deal with abnormalities immediately.
(5) Explain the condition to the patient’s family and listen to their opinions while explaining the resuscitation measures.
Observation and care during hemoptysis
Be highly alert to the reoccurrence of hemoptysis after the asphyxia is lifted, closely observe the patient’s respiratory movement, state of consciousness and the data displayed by the cardiac monitor, and keep records. Pay attention to the premonitory signs before hemoptysis: such as chest tightness, chest pain, violent cough, breath-holding, cyanosis of the lips and nail bed, pallor, irritability, etc. Absolute bed rest should be taken to avoid moving, turning and coughing, talking loudly; head to one side and take the affected side to reduce the activity of the lungs, which is conducive to hemostasis and can avoid blood flowing into the healthy side, leading to asphyxia. Encourage the patient to eat more, avoid stimulating food, give sputum-forming drugs to dilute the sputum, and assist the patient to remove the residual blood clots in the trachea to prevent asphyxia and other complications. When the patient feels blood in the throat or itchy, instruct the patient to tilt the head to the outside of the bed and gently cough out the blood through the mouth without exerting too much force or holding the breath so as not to cause greater hemoptysis or even asphyxia, and observe the amount, color, and presence of lung tissue of the hemoptysis and record it. If the patient appears pale, sweating, palpitations, dyspnea or abdominal pain, stop the sedation immediately.