What do you think is the indication of branchial angiography (BAG)?
Recently, I saw a patient who visited our hospital with a complaint of blood from mouth (initially, origin of blood was unknown). With a massive blood coming from his mouth, his respiratory condition quickly worsened. Immediately, respiratory ventilation after the tracheal insertion was required. During the hospitalization in ICU, over 500 ml of hemoptysis was intermittently observed. Enhanced CT revealed no evidence of extravasation except the markedly dilated right bronchial artery and coagulation in the bronchi of the right lower lobe. Circulatory condition was constantly stable. We were at a loss whether this patient is recommended to undergo some kind of hemostasis. Does anyone know the indication of BAG as well as hemostasis? Finally, he was sent to a tertiary emergency medical center for further examination and treatment. Please let me know if anyone has a good idea. hemo
Dear Nobuhiro,
regarding hemostasis it is prudent to carry out detailed point-of care analyses (thromboelastometry/thromboelastography, platelet function assays).
For ongoing bleeding episodes: systemic hemostatic drugs such as tranexamic acid and desmopressin could be useful.
Hemoptysis (500ml) is quite a lot. I would consider administering FVIIa or Novoseven to control the bleeding. The dose should be carefully calibrated in order to avoid thrombotic complications. Bronchial angiography may be indicated and site-directed application of fibrin glue may be useful in such conditions. Desmopressin (DDAVP), Tranexamic acid or aprotinin may be helpful.
- Badges
- Science topic
- Similar topics
- Chemistry
- Pharmacology
- Medical Pharmacology
- Clinical Pharmacology