Tuberculosis Study Guide - M. M. Savula 2002

Complications of pulmonary tuberculosis
Hemoptysis and pulmonary hemorrhage

Hemoptysis and, in particular, Pulmonary Hemorrhage are dangerous Complications of Pulmonary Tuberculosis. Hemoptysis is defined as the presence of Blood streaks in the sputum or coughing up individual blood spits of up to 50 ml per day. The discharge of a larger volume of blood is considered a hemorrhage. The cause of hemorrhage is a breach in the integrity of the pulmonary or bronchial vessels. Increased permeability of the vascular wall can also cause hemoptysis. Triggering factors may include cold, significant fluctuations in atmospheric pressure, overheating, and acute or chronic Alcohol poisoning. Pulmonary Hemorrhage and Hemoptysis typically begin with a tickle in the throat, sometimes a sensation of suffocation, and invariably with coughing, followed by the expectoration of blood-streaked sputum or pure, bright red, sometimes frothy blood. This requires immediate emergency medical care. The patient, who may be panicked by the sight of blood, should be reassured and placed in a semi-sitting position to facilitate the coughing up of blood clots.

There are no sufficiently effective means for providing aid at home; however, in emergency situations where medical assistance is delayed, the patient may be offered to drink a hypertonic saline solution (1 teaspoon per 1/2 Glass of Water) in slow sips. Swallowing ice or applying an ice pack to the chest is not recommended. Food should be semi-liquid and warm (but not hot). In case of hemorrhage, tourniquets are applied to the lower extremities for 35-40 minutes, after which they are loosened for 5-10 minutes and then reapplied. The pressure of the tourniquets should be adjusted so that the pulse in the popliteal fossa is preserved, and the patient does not experience pain or coldness. As a result of this manipulation, the blood flow from the systemic Circulation to the Lungs is reduced, and clotting factors enter the bloodstream from the Tissues, helping to reduce bleeding.

If medical assistance is available, the patient with pulmonary hemoptysis is given ascorbic acid 0.1 g 45 times a day or ascorutin - 0.5 g three times a day orally. Sodium ascorbate 5% - 5-10 ml can be administered intramuscularly or intravenously, vikasol 1% - 1-2 ml intramuscularly, or adroxon 0.025% 1 ml intramuscularly or subcutaneously. To stop and prevent recurrent hemoptysis, dicynone (ethamsylate) 12.5% - 2 ml is prescribed intravenously or subcutaneously, or 0.25 g orally. Epsilon-aminocaproic acid is prescribed orally at 5 g 4 times a day or by intravenous infusion as a 5% solution of 100 ml. A common remedy for pulmonary hemoptysis is the intravenous administration of a 10% solution of calcium chloride or calcium gluconate. Antitussives are given only in cases of uncontrollable coughing. The emergency first aid kit must be equipped with these medications.

In the pre-hospital stage of pulmonary hemorrhage, the same medications are administered, and tourniquets are applied to the limbs. The prognosis of Pulmonary hemoptysis and hemorrhage is difficult to predict; therefore, the nurse must immediately notify the doctor, and the paramedic must call an emergency medical team, which will assess the feasibility of transporting the patient and carry out their hospitalization.

In the hospital, while continuing hemostatic therapy, a series of examinations are performed (clinical and radiological, coagulation profile, and, if necessary, bronchoscopy) to clarify the Diagnosis and assess the state of the Blood Coagulation SYSTEM. This helps target further Treatment. Virtually all patients with pulmonary hemorrhage exhibit increased Fibrinolysis. Therefore, its inhibitor, epsilon-aminocaproic acid, is prescribed: in cases of blood loss exceeding 500 ml, it is administered as a 5% solution - 100 ml via intravenous infusion up to 4 times a day. As the bleeding subsides, its oral administration is continued at 5 g, up to 15-20 g per day. To enhance the coagulation Properties of the blood, 200 ml of fresh frozen plasma and 10% medical gelatin - 10-30 ml are transfused. For patients with a confirmed low level of fibrinogen in the blood, fibrinogen is administered by intravenous infusion at a dose of 2 to 10 g per day, dissolved in isotonic sodium chloride solution with The addition of 5-10 thousand units of heparin.

High pressure in the pulmonary vessels contributes to ongoing bleeding; therefore, patients with elevated or normal ARTERIAL BLOOD PRESSURE are given an intravenous solution of aminophylline 2.4% - 10 ml. Reducing pressure in the Pulmonary Circulation is facilitated by the administration of antispasmodics: papaverine 2% - 2 ml, No-Spa 2% - 2 ml, or atropine sulfate 0.1% - 1 ml subcutaneously. In cases of significant blood loss, patients are indicated for infusions of polyglucin, rheopolyglucin, gelatinol, packed red Blood Cells, or native or dry plasma.

Simultaneously with hemostatic and replacement therapy, patients are treated with a combination of antituberculosis drugs, as hemorrhages most frequently occur against the Background of tuberculosis exacerbation.

Complications. The aspiration of blood into the lungs causes The Development of aspiration Pneumonia; therefore, In addition to antituberculosis drugs, broad-spectrum Antibiotics must be prescribed, sometimes in combination with glucocorticoids.

Death from asphyxia occurs as a result of airway obstruction by blood clots. At the first signs of suffocation, blood must be immediately removed from the Bronchi using a catheter or bronchoscope. To relieve concomitant bronchospasm, bronchodilators and atropine sulfate are administered.

If conservative treatment is ineffective, an attempt is made to achieve bronchoscopic hemostasis; in cases of recurrent hemorrhage, Surgical treatment (most commonly resection of the affected lung area) is performed as indicated.

Questions

1. What is meant by hemoptysis and pulmonary hemorrhage?

2. What measures can be taken for hemoptysis and pulmonary hemorrhage at home?

3. What is the recommended regimen for a patient with hemoptysis (hemorrhage) regarding positioning and Nutrition?

4. What medications are administered to a patient with hemoptysis?

5. What drugs are administered to patients with significant blood loss?

6. What complications can arise in patients with pulmonary hemorrhage?

7. What medications should be administered for the Prevention and treatment of aspiration pneumonia?

8. What measures are taken when a patient is threatened with asphyxia?