Coughing up hemoptysis (i.e. hemoptisis) is a very unpleasant symptom. True, at first it is not clear what disease. But do not immediately panic in this situation. First, you need to observe the frequency of such a symptom, the color and amount of blood released, as well as the composition of sputum.

Secondly, turn to a medical institution for help in determining the source of this phenomenon, since hemoptysis is a rather alarming signal about a violation in the functioning of your body. Therefore, pull with a doctor’s appointment is not worth it.

On a note! Most often, hemoptisis is observed in people already matured (approximately 50-60 years old).

Color and composition of the discharge of the bronchopulmonary system

The color released when coughing blood may be:

• Pink.
• Bright scarlet.
• Very dark (i.e. brown).

On a note! Hemoptysis is the secretion of mucous or purulent-mucous sputum during a cough. Do not confuse this phenomenon with the presence of blood in the saliva due to bleeding from the nasal cavity or gums.

In sputum can be observed:

• The presence of bloody veins.

• Heavy bleeding. It is usually foamy.
• The presence of blood clots.

Important! Regardless of whether you simply have hemoptysis or bleeding, you need to undergo a full examination of your health condition.

In terms of the volume of secretions, there can be quite a bit (up to 100 ml per day), and maybe a lot (over 500 ml): it all depends on the existing pathology. In the case of heavy bleeding, you can’t hesitate, urgent hospitalization with subsequent bronchoscopy and, possibly, surgical intervention is necessary.

The causes of the disease

Possible causes of hemoptysis:

• Respiratory diseases (e.g., inflammation or emphysema, as well as pneumonia). In the culmination period of these diseases, there is a high temperature and the release of either pure blood or small blood clots.

On a note! In the case of pneumonia, the blood in the released sputum has a rust tinge. In addition, with this ailment, shortness of breath, fever and pain in the chest area are observed.

• Pulmonary embolism. As a result of the development of this disease, clogging of the branches of the lung occurs with blood clots.
• Mitral valve stenosis (i.e. narrowing) is an acquired heart disease and is quite common. In this disease, in the sputum released, after which it becomes much easier for the patient, only blood streaks are observed.
• An abscess of the lung, that is, a purulent-destructive process in the organ. Very often accompanied by profuse blood loss.
• Hemorrhagic hemostasiopathy.
• Cancer tumor.
• Rupture of an aortic aneurysm followed by its contents entering the bronchi. It happens extremely rarely.

Important! The disease is rapidly developing and in a matter of minutes can lead the patient to death.

• Dystrophy (amyloid).
• Injury of a mechanical nature due to improperly inserted catheter into the artery by a medical professional.
• Pressure sores. Oddly enough, but nonetheless it is. That is, with a long stay in the same position in patients, sputum with blood can leave due to the death of some part of the lung tissue.

On a note! To avoid such phenomena, it is often necessary to turn the patient from side to side, as well as use a special mattress designed to prevent bedsores from forming.

• Heart and vascular disease (e.g., left ventricular failure, myocardial infarction, hypertension, or cardiosclerosis). With all these pathologies, a rather severe attack of cardiac asthma is first observed, and then foamy bloody discharge in the sputum. Moreover, at first the blood has a scarlet color, then darker.
• Sternum injuries. Moreover, sometimes the pathology can be observed without visually broken ribs or other injuries.

Important! If the cough does not go away for a long time and sputum is bleeding constantly with blood, do not pull with a trip to a medical specialist. Remember: any disease at an early stage is easier to treat.

We will dwell in more detail on only a few points.

Pulmonary hemorrhage (hemoptysis, by the way, can occur with or without coughing) is characterized by a large volume and scarlet color of blood, which foams and practically does not clot. In this case, do not hesitate. An ambulance should be called immediately, as hospitalization should be carried out on an emergency basis.

Causes of hemoptysis and pulmonary hemorrhage:

• Tuberculosis.
• Lungs' cancer.

Blood discharge for tuberculosis

Characteristic signs of a disease such as tuberculosis are:

• Dry cough, the intensity of which decreases or increases.
• Pain in the sternum, associated directly with pleural inflammation.
• Regular fever.
• Hemoptysis with tuberculosis is a fairly common occurrence.

On a note! If haemoptysis is observed in heavy smokers for a long time, then this is a sure sign that a tumor could appear in the lungs. See your doctor for advice.

Hemoptysis with tuberculosis is characterized in that as the disease develops, the amount of blood in the sputum released is constantly increasing.

Cancer tumor

Hemoptysis, along with other symptoms (for example, migraine, pain and fatigue), is a characteristic feature of such a serious ailment as cancer. At first, this manifestation of the disease scares, and subsequently very exhausting a suffering person, whose condition over time, everything worsens and worsens.

Hemoptysis in lung cancer is due to the fact that there is a destruction of the mucous membrane of the bronchus and rupture of blood vessels under the influence of neoplasms. The type and volume of hemoptysis depends on the location of the tumor. That is, from how close it is to the bronchi. At first, hemoptysis in cancer looks like purulent-mucous sputum with small veins. Further, the process aggravates, and the secretions already contain blood clots. In this case, emergency measures must already be taken.

What precedes hemoptysis

Harbinger of hemoptysis may be such phenomena as:

• Coughing or tingling sensation in the throat (i.e. tickling).
• Feeling of discomfort in the abdominal cavity and a sickening state. Moreover, the presence of a small amount of blood is already observed in the vomit, reminiscent of a bright red aniline dye.

Important! At the first appearance of blood in the process of coughing, you should immediately contact a medical institution for qualified help. Only a doctor can prescribe the necessary examination and make an accurate diagnosis. You should also go for a consultation with a specialist if, during hemoptysis, the temperature rises to significant levels. And also there is weakness, shortness of breath, dizziness and even loss of consciousness. Treat your health more carefully. Take care of yourself.

Diagnosis of hemoptysis

As mentioned earlier, not all hemoptysis symptoms indicate serious illnesses. But in order to be convinced of this, it is necessary to carry out a whole complex of diagnostic measures aimed at identifying the source of sputum released with blood. That is, it is very important to have reliable information about where it comes from: from the digestive tract, respiratory tract, and maybe from the nasal cavity or mouth. The diagnostic algorithm is as follows:

• First, the doctor visually examines the patient, including listening to the lungs using a phonendoscope, as a result of which local rales or noise can be established, indicating any pathological changes associated with a serious damage to the lung membrane.
• Next, clinical trials (that is, general tests) of sputum are performed (in order to detect pathogenic microflora and determine its sensitivity to antibiotic drugs) and blood.
• For a more accurate diagnosis, an x-ray examination of the patient's chest can be prescribed. Using this image, the doctor gets a clear idea of \u200b\u200bthe possible damage to the lungs and bronchi, as well as the severity of the disease.

On a note! Even if you have on hand the results of an x-ray, indicating that everything is normal, there is still the likelihood of the presence of diseases such as cancer or bronchiectasis.

• Based on the signs of hemoptysis, in some cases a study such as tracheobronchoscopy is prescribed. Such measures using a bronchoscope will not be superfluous with copious sputum production with blood.
• Sometimes it is necessary to conduct a computed tomography (i.e. CT) scan of the sternum.
• At the discretion of the attending physician, other diagnostic methods may be prescribed.

Important! If the patient has repeated hemoptysis, he is again prescribed a full examination, not taking into account previous diagnostic measures. That is, each subsequent case is considered as the first. And it is right.

Help with pulmonary hemoptysis

What is the first aid for hemoptysis:

• Do not lay the patient horizontally. We give the person such a position so that the head is taller, that is, the best option is half-sitting.
• If hemoptysis occurs for the first time, then the patient is afraid. A panic might overwhelm him. We reassure him, explaining that everything will work out, and there is nothing wrong with what is happening.
• We forbid the patient to make any movements. You can’t talk either.
• We put an ice bubble on the sternum area and suggest that the sick person swallow a piece of ice (small in size). A spasm of a reflex nature may minimize the risk of serious complications.

Important! In no case do not put mustard plasters, banks, hot compresses and anything like that on the chest area.

• Before starting all measures to assist the patient, we call an emergency car. We inform the dispatcher what specifically bothers the person and how this is manifested. In emergency cases, a special resuscitation team can be sent to provide emergency care for hemoptysis.

In-patient hemoptysis treatment

Therapy of the disease in stationary conditions is reduced primarily to the localization of the source of hemoptisis in the respiratory tract, that is, to get rid of the disease that provoked the release of sputum with blood (for example, cancer, pneumonia or tuberculosis). In addition, of course, the patient is prescribed hemostatic and antitussive medications. Moreover, in the treatment of hemoptysis, bed rest is required.

On a note! First of all, in all patients complaining of hemoptysis, they carefully examine the cavity of the pharynx, mouth and nose in order to identify sources of bleeding. Sometimes the cause of hemoptisis can even be gum damage under the dentures.

In the event that the bleeding is severe, it is unlikely to avoid a blood transfusion. And if blood loss is about 800 ml, then surgical intervention cannot be ruled out. Using a bronchoscope, they find the source of bleeding, and then perform actions to isolate a healthy lung, providing ventilation.

Important! Removal of the affected part of the lung is not carried out in the presence of inoperable cancer or severe pathology of the function of external respiration.

A patient with hemoptisis should be constantly supervised by doctors, as his health condition may worsen at any minute (in this case, he will be transferred to the intensive care unit). Doctors should monitor the patient’s blood pressure and heart rate.

What they can’t do:

• Make quick and sharp movements with the body and head.
• Eat fatty foods.
• Significantly strain the vocal cords, that is, raise the voice and scream.
• To drink "strong" drinks.
• To smoke.

• Allow constipation. To do this, it is recommended to take special drugs that promote bowel movements, as well as put enemas.
• To stay for a long time in stuffy and unventilated rooms.
• Load yourself with physical exercises or refuse them altogether if the doctor insists on it.

Remember! Hemoptysis is very serious, and you should not be negligent. Therefore, all the recommendations of your doctor should be strictly observed.

Therapy with traditional medicine

Apply such methods with great caution and only after a thorough diagnosis in a medical institution and consultation with your doctor. Otherwise, quite unpleasant consequences are possible that you are unlikely to like.

• Rub the seeds (not dried) of the milk thistle plant and mix them with hot water in a 1: 1 ratio. We insist for 30 minutes, filter and drink 50 ml three times a day.
• We mix (in equal proportions) the leaves of nettle, the common flax, chicory and mountaineer. Pour 2 tablespoons of the obtained herb collection with boiling water (350 ml) and insist under the lid for an hour. Then we filter and take 100 ml inside three times a day. The course of treatment is 1-2 weeks.
• Mix (in equal proportions) raisins and prunes. Pour a glass of the resulting fruit mixture with water (one liter), add a little sugar and cook the compote. We drink 2 glasses every day.
• Squeeze the juice from the rabbit cabbage and sorrel. Each is placed in a separate container. During the day, it is recommended to take twice a tablespoon of each of the juices.
• We drink a decoction made from quince seeds.
• We mix the leaves of mint, nettle, yarrow and hemophobia in equal proportions. Pour 1 tablespoon of herbal collection with boiling water (200 ml), infuse, filter and take 150 ml inside.
• We drink juice squeezed from radish.
• We prepare the nettle infusion in the classical way and take it in the usual dosage.
• We mix (20 g each) the leaves of the highlander, rotundifolia, wild strawberry, white mistletoe, wormwood, shepherd’s bag, wheat grass creeping; as well as rhizomes of the mountaineer snake and cinquefoil. Then we fill 4 tablespoons of the herbal collection with very hot water (0.5 liters), insist in a thermos, filter and drink all the contents in 3-4 approaches.
• In the usual way, we prepare an infusion from the grass of a shepherd’s bag and boiling water in a proportion of 1:10. Take three times a day for 1 tablespoon. The infusion is recommended for pulmonary hemorrhage.

Important! We remind you once again: hemoptysis is an extremely serious disease. Therefore, self-medication is unacceptable.

Prevention

Preventive measures are very important in the fight against such an ailment as hemoptysis. What should be done first?

• You should try to lead a healthy lifestyle in order to avoid the occurrence of diseases of the respiratory organs and the cardiovascular system.
• Refuse such a bad habit as smoking.
• Correct your diet. That is, fatty and spicy dishes should not be included in the diet. Better to cook food for a couple, in extreme cases, just boil. Servings should be small.

On a note! Only the diet of a person suffering from tuberculosis should have a high calorie content. This is necessary to recover from a serious illness.

• Try to avoid overwork, stressful situations and nervous overload.
• Often drink cool water in small sips.

• Do not give the body great physical exertion, including exercise in the gym. In no case do not lift weights.
• The room in which you have to be a sick person, you must often ventilate. The room must be kept at a low temperature. Heat is unacceptable.
• Take more walks in the great outdoors.
• In case of heat, pour cool water over the neck and head.

In custody

Remember: hemoptisis can be a symptom of a very serious pathology. It cannot be ruled out for a patient and death. Therefore, do not self-medicate, do not waste precious time in this situation. Contact a medical specialist. Only after carefully conducted studies can a diagnosis be made and the necessary treatment prescribed. Only in this way and nothing else. Further, after the crisis has passed, you can use traditional medicine in consultation with your doctor.

Blood sometimes comes out in saliva - then it oozes from parts of the mouth, sometimes it comes out with blowing and expectoration and oozes from the throat, and sometimes it comes out when coughing and oozes from a tube.

It happens that blood comes out when vomiting occurs - then it oozes from the esophagus or from the stomach or from the liver, and sometimes it comes out with a cough and oozes from the chest and lungs. Bleeding from the chest is not as dangerous as bleeding from the lungs, because bleeding from the chest quickly passes, and if it does not, it does not have the harmfulness of an ulcer in the lungs. Bleeding from the lungs often turns into an ulcer with a fistula, which forms again, and is accompanied by hemoptysis.
The immediate cause of all this is a wound due to some external circumstance, such as a hit or fall on the chest, on the liver or on the abdominal barrier, or from something cutting, or stubborn cough, from screaming, from raising the voice without gradualness, or from irritation. Therefore, such hemoptysis is often observed in possessed people, and in whom, they are irritated for any reason. Sometimes hemoptysis occurs from severe vomiting, especially in people predisposed to this. And sometimes it starts after taking sharp laxatives or sharp nutrients like garlic and onions, or from fear or grief that makes the blood sharp, or from sleeping on an uneven bed, or from a leech that sticks to the throat inside, and also from some kind of binder causes.
  This reason is either rooted in the vessels, or located outside the vessels. The reason, rooted in the vessels, is either rupture, or splitting, or opening and expansion due to the sharpness of the juice, or relaxation, or erosion by acute juice, or the thinness of the vessels, which contributes to the leakage of blood. Often the passages between the parts of the tube and the arteries expand more than natural, and blood seeps into the tube.

As for the causes that are outside the vessels, it is either a wound or an ulcer from a wound or from erosion and decay, if something has burst in the organ. Sometimes hemoptysis is due to a bloody tumor in the lungs from which blood leaks. Such a tumor is benign, because it is bloody and exudes matter, but does not delay it, and the matter in it is not dense. All these causes, with the exception of leeches, are also in the lungs. These linking causes have reasons that precede them, such as the abundance of blood matter that arises either from heavy food and the cessation of exercise, or from the fact that the amount of blood exceeds the natural supply. This happens, as we established in the Book of General Issues, due to the cessation of physical exercise or due to the retention of bleeding during menstruation, during stool, or when some organ is cut. This also happens due to the attraction of blood matter to certain organs due to its increased movement or due to the presence of winds in the vessels that rupture them, especially in lean people; they often do this. The cause of an excess rush of blood is the predisposition of blood-containing organs, which arises from the cold, compressing them and making them difficult to expand, so that these organs, subject to coercive force, do not stretch, but break. This also occurs from heat, external or internal, or from dryness. Any of these qualities predisposes the vessels, tightening and drying them, to rupture from an insignificant reason, and among other things, from moisture, which loosens them and expands their mouths. It also happens from contact with something tearing, corroding or causing decay.
  When there is an overflow of blood, then the nature begins to drive matter to the side where it is possible, since the organs on this side are more capable of erupting the surplus or are closer to the place of their eruption, and expel it by hemoptysis or outpouring from the kidneys or in the form menstruation or nosebleeds. If the vessels are strong and are not exempted from blood, then sudden death occurs due to the outpouring of blood in the vascular cavity.
A person who has hemoptysis is threatened with the formation of an ulcer in the lungs, because hemoptysis is most often from a wound, and the wound easily turns into an ulcer. If, after the cessation of hemoptysis, it begins again, then one can fear that this secondary hemoptysis occurs due to an ulcer into which the initial wound turned.

It often happens that the patient sputters blood, which, when bleeding from the nose, gets from the head to the lungs. When blood oozes from the region of the lungs during hemoptysis, there is a twofold danger: the danger of excessive bleeding and the danger that the wound in the lungs will turn into an ulcer. Not all hemoptysis is dangerous, but only one that cannot be stopped, or one with which there is a fever. Hemoptysis is often the cause of a cure for a tumor in the liver or in the spleen.
  Signs  Blood that is close to the larynx is expectorated with a slight cough, and far from the larynx, with a strong cough. The farther the blood, the stronger the cough that accompanies hemoptysis. When they lie on the side where the cause of the disease is rooted, the amount of expectorated blood increases. You should first carefully look to see if the blood comes from the nose, which the patient expectorates. This is recognized by the fact that nosebleeds in this patient are common and happen often, and heaviness in the head after bleeding is replaced by lightness. Signs of nosebleeds are, for example, redness of the face and eyes, lightning in front of the eyes and the fact that the blood does not foam and spills out at once.
  A sign of bleeding from the substance of the meat of the lungs due to a wound or ulcer is that the blood foams, that it goes intermittently, and that there is no pain. Such bleeding is less in number than bleeding from a vessel, but it is more dangerous and malignant in its consequences. Sometimes patients with pleurisy and pneumonia cough with foamy blood, if they have a fiery heat in their lungs, causing the blood to boil. Sometimes foamy blood comes from the pulmonary tube, but it appears with expectoration of a sputum and a slight cough; however, the amount of separated blood is also not large, and there is some sensation of pain.
  The substance expectorated from the vessels of the tube does not foam; it is hotter and denser to the composition than the blood in the lungs, and more like healthy blood, although not as thick as the blood in the chest.
Signs of bleeding from the chest are black, the density and density of blood due to the distance from the chest to the throat, as well as some frothiness and scale, and a sensation of chest pain indicating the place of the disease; this is reinforced by the fact that the pain intensifies. When they lie in a sore spot; The cause of pain is the abundance of nerves in the organs of the chest. Blood is released little by little, not continuously; hemoptysis is accompanied by a strong cough, which lasts until it ends. This is one of the symptoms of a pulmonary infarction.
  A sign of hemoptysis from rupture of the vessel is an abundance of blood, and a sign of corrosion is that hemoptysis was preceded by causes that cause corrosion, for example, the ingestion of caustic substances and the descent of caustic catarrh, as well as the presence of fever and expectoration of pus and films or lung particles, and expectorated sputum is like meat juice. The blood flows first little by little, then sometimes it breaks out at once, and the patient sprinkles a fair amount of blood of a bad color.
  Signs of the opening of the mouths of the vessels from overflow are the complete absence of pain and the fact that expectoration causes a feeling of relief and well-being; at first less blood comes out than at the beginning of hemoptysis from rupture or opening of blood vessels, but in most cases it is more than when hemoptysis from erosion. A sign that blood seeps out of the tumor is its small amount and the presence of signs of inflammation of the lungs and other organs.

  Treatment. If the patient constantly coughs up blood, then you need to monitor what is the degree of filling his body with juices. Whenever an overflow is noticed, it is necessary to bleed him as soon as possible, especially if his chest is naturally narrow or he is overcome by a persistent cough. In such patients, it is best to direct blood to the lower half of the body, opening first the sacral vein, and then opening the basil. If women have a period of menstruation at such a time, and moreover in a sufficient amount, then hemoptysis stops, just as it sometimes occurs with a delay in menstruation. You should beware of everything that sets the blood in motion, for example, strong medicines and jumps, jumping, screaming, irritating, copulating, taking deep breaths: you should not talk too much, look at something red, drink a lot of wine and go to the bathhouse. A person suffering from hemoptysis should avoid opening vessels of drugs, for example, celery, sabur, sesame, wine and old cheese, because it is harmful to such patients, while fresh is useful. Food suitable for them is everything that sticks together and clogs, everything that splices, and everything that cools the blood and does not allow it to boil. This includes boiled milk, as it sticks together, and cow buttermilk due to its astringent properties, as well as butter, fresh, unsalted cheese, astringent fruits in the form of small plums with astringent properties. Freshly squeezed oil of unripe olives is sometimes used to flavor the food of such patients. Alum water is very beneficial for them. As for bleeding from the body of the lungs itself, the patient is given to drink dry splicing drugs, for example, clay or blood with plantain juice and vinegar diluted with water.

As for the treatment measures, in addition to the diet, it is necessary to bleed as soon as possible from the basilica from the side where, as they suspect, the collapse of the single; bloodletting is done with a narrow incision and blood is taken several times, with intervals of three hours or so, taking into account the patient’s strength. Bloodletting diverts blood to the other side, and also prevents the formation of swelling and wounds. These patients are rubbed limbs and tightly bandaged them, starting from top to bottom, and forbid them all that is mentioned above. The air in their room should be balanced, and they should lie on their sides or sit almost upright so that some parts of the chest do not press on the other. Sometimes it helps to water them with vinegar diluted with water: it prevents bleeding and cleanses the area of \u200b\u200bthe chest and lungs from blood if it lingers there, but does not thicken it. They are also watered with cold and gluing drugs, for gluing is the first thing to do here; if, along with gluing, peeling also takes place, then this is the limit of what is desired. Psyllium psyllium helps such patients with its cooling effect when a strong thirst is felt.
  Often it is necessary to mix substances that cause numbness to drugs, and this is done for two reasons: firstly, to soothe the blood and make it liquid, and secondly, to euthanize the patient so that he stops moving. We will also mention common remedies for various types of hemoptysis at the end of this section. If hemoptysis occurs due to catarrh and catarrh is not very caustic and not jelly-like, you immediately bleed blood from the vessels of the legs and bandage his legs, descending from top to bottom. You also rub them with hot olive oil or other hot oils, for example, mad cucumber oil or the like, but they don’t lubricate your head at all.
Such patients are fed with dishes in the form of a stew of wheat with something tart. These tart condiments are prepared from fruits or the like. If they are weak, they are fed with bread soaked in vinegar diluted with cold water; acute enemas are also used to distract matter from the head region, especially if blood cannot be allowed in due to any obstruction. You should try to cool your head as much as possible, without making intensive efforts to moisturize it. One of the remedies useful to such a patient is to give him amber cakes. And if all of what we mentioned does not work, then we inevitably have to treat Qatar and delay it by shaving the head and applying medical dressings with pigeon feces, which are applied and removed, depending on need.

Galen says that one woman had bleeding from a catarrh, and he gave her an acute enema. He did this mainly because it was impossible to apply bloodletting, since the patient had been coughing up blood for four days and was very weak. Galen fed her with a harirah and slightly astringent fruits — and she had not eaten anything for a long time — and smeared her head with medicine from pigeon feces; he allowed the patient to go to the bathhouse because of this medicine and did not smear her head with oil, so as not to moisturize her. Then he watered her with a fresh teriyak to euthanize her - this is a teriyak with strong opium, which euthanizes, stops tickling from coughing and somewhat calms the expiration of matter, thickening it. And on the second day after this treatment, Galen did not make the patient move, but, on the contrary, left her lying calmly and motionless, although her lungs had to be cleaned, and the most that he used was rubbing her limbs; [in addition, he again gave to her to drink fresh teryak less than the day before: his goal was to gradually accustom the patient to honey in order to cleanse her lungs. After that, he left her alone, then again began to rub her and then gave her barley water and some bread to revive her strength. On the fourth day, he gave this woman an old teryak with a lot of honey in order to cleanse her lungs greatly, and in the following days nourished her, as it should, applying the regimen of recovering patients to her. Moreover, from time to time he smeared her head with wax ointment with tapsia and did not allow her to go to the bathhouse. This is a great way of treatment, and the teryak should be aged from two to four months: it euthanizes and delays catarrh. Oil should not be brought to the head of such patients; when using drugs that cause redness, it is necessary to shave the head, even in women. The relaxation of the stomach cannot be avoided, for example, with cucaya pills, if there is an abundance of matter; this should be done after bloodletting and then constantly take medications that cause redness of the head.

When hemoptysis due to opening or rupture of a vessel, the cause of which is overflow, should, as far as possible, not to feed the patient; on the contrary, let him starve for three days, limiting himself at this time to taking a small amount of something sticky broth every day. If there is no loss of strength, then food, if possible, is postponed until the fourth day, and if there is a fear that the forces will fall. And if there is a well-founded fear, then the patient is fed with substances that generate juice of moderate warmth or coldness, and at the same time glues and viscous juices, which also have the ability to bind with drugs and, especially, to thicken blood with food. Such, for example, harisa with cow legs. Animal heads, soft-boiled eggs, noodles, especially cooked with lentils, or lentils with jujube. If it is possible not to feed very nutritious, then they do so, confining themselves to barley water, especially boiled with lentils, jujuba or quince, or bread soaked in cold water or in something sour or sour, and all this should be cold in practice. Coughing, if the illness lasted, is useful for its astringent properties and coldness. Boiled milk is useful in this case due to its adhesive properties and stickiness, but not boiled milk increases the amount of blood and causes harm.
  Fish from reservoirs with a rocky bottom very blinks to such patients. It is appropriate that the food of such patients or those whom we will discuss below be cold in practice. Fresh, unsalted cheese brings them very great benefit. And if you feed such a patient and similar to him meat, then choose meat in which there is little blood, dry and light, what is the meat of doves, kata and turcoche, and boil with astringents and astringents. One of the tested measures for breaking off hemoptysis is chewing portulak garden and swallowing its juice; sometimes it stops hemoptysis immediately. Of the fruits, quince and apples, astringent and astringent fruits, fresh jujube, as well as seeds of myrtle, Syrian horns and what is similar to them are useful. Sometimes for such patients a snack is prepared from printed and Armenian clay with Arabian gum and a small amount of camphor.
When the blood stops and the disease reaches the fourth day, the patient should be intensely nourished and strengthened. Start, for example, with bread soaked in water, or with the heads and legs of animals and their brains. If hemoptysis occurs due to the opening and rupture of the vessel due to the sharpness of the blood, then it is treated like this: they do what follows in relation to the deviation of blood to the limbs, in the opposite direction from the lungs, and yellow bile is removed, and then it is very cooled and moisturized. They also use astringents and adhesives, barley water, crayfish, pumpkin, Andromache medicine and Galen medicine.
  If hemoptysis began as a result of the opening of blood vessels, then the medicines that should be used are astringent and tart and at the same time gluing medicines, just as gluing, splicing, and astringent drugs were required in the previous type of hemoptysis. And the medicines that are useful for hemoptysis due to vasodilation are, for example, the color of pomegranate, cups of pomegranate flowers, sumy, squeezed juice of the tharisis - Cynomoriumcoccineum, squeezed juice of the stalks of grapes, acorns, buckthorn leaves, amber, acacia, hudad, squeezed rose juice, squeezed juice of the “shepherd’s staff”, tatarnik, squeezed juice of unripe grapes and hiyufastidasa. Sometimes these substances and what is made of them are reinforced with alum, ink nuts, sabour and bitter wormwood, and they are complex drugs; flat cakes intended for diseases of this kind are sometimes prepared from the aforementioned medicines. Often these drugs are boiled in pure water or in some squeezed juices and drink a decoction, and sometimes medicinal dressings are made from them. For example, celery, ajgon, anise, sumbul, ramik are mixed with these medicines, and with all the mentioned medicines for hemoptysis, as well as with breast medicines, or add substances that cause numbness, for example, bark of mandrake roots, bleach, and sleeping pills . They also mix gluing agents, such as gum, frankincense, "Samos star", bamboo nodules, large plantain seeds, flea plantain mucus and its seeds, squeezed portulaca juice, quince seed mucus. And if expectorated blood oozes from the tumor, then the treatment is to bleed, empty and then bring the tumor to maturity. Such hemoptysis is not treated with astringents, for it entails great danger; on the contrary, it should be treated as pneumonia is treated.
As for hemoptysis, resulting from erosion, its treatment is a difficult, difficult and hopeless case, because it is healed and the ulcer heals only when the disorder of nature disappears, and this happens only at such a time during which the ulcer either hardens, or rots. However, sometimes it is useful if the corrosive beginning is not allowed to harden and the hot juice is removed. Often, yellow bile and thick matter are simultaneously removed using, for example, agaric pills; if you need to strengthen this medicine, strengthen it and try to calm the tickling from cough with seed medicine; it is hoped that it will bring some benefit. But in general, the treatment of such patients consists in cleansing by emptying, bloodletting and other measures, as well as in the nutrition of substances that give a good chyme. Sometimes corroding ulcers heal: from the incense, myrrh, large plantain, Purslane seed, garden marshmallow root, “star” cakes with half of the opium added, as well as the complex medications mentioned by Paul and mentioned in the Pharmacopoeia. Useful of these medicines are those that include blood, dragon's blood, amber, sandarak, printed clay and in general everything that dries, glues and splices.

As for bleeding from the chest, it is treated with medicinal dressings and medicines containing a diluted substance, or they are given a diluted substance mixed with them - we have already mentioned these medicines - so that the medicine can reach the breast; juice of mountain basil combines both of these properties. If it is assumed that the cause of hemoptysis is fever, then all the medicines mentioned are suitable, and if they suspect that the cause is the cold that caused hemoptysis in the manner described above, then his treatment, as Galen says, is as follows: if hemoptysis affects a young man, then it they are treated by opening blood on the first day and on the second day, as well as rubbing the patient's limbs and bandaging them in the same way as this should be done to stop any bleeding. Then he is fed a stew and a proper medicinal dressing with a wax tapsia ointment is placed on his chest. In the evening, the bandage is removed so that the warming does not exceed the desired degree, then the patient is fed again with pottage and given him medicine with seeds. On the third day, this bandage with a wax ointment is applied to the chest for three hours, then it is removed and given to the patient with barley water and isfidge with duck meat. When the nature of the lung becomes balanced and the danger passes that a tumor will form, the patient's lungs are cleaned with an old, full-fledged teryak and gradually accustom him to donkey milk and, in general, to the regimen of patients stained with blood. Galen claims that all such patients, whom he captured on the first day, recovered, while others had a different condition. We also saw patients who benefited from this or a similar method of treatment.
If it is assumed that the cause of hemoptysis is moisture and relaxation of the respiratory muscles, then substances with drying, warming and astringent properties are used. Aromatic root of chinacea, mastic, roasted cumin, mountain mint, cadcalis, beaver stream and saffron, cakes of them are allowed to be swallowed; sometimes they are mixed with moderately astringent drugs, such as chestnut, and sometimes they are made from them complex drugs mentioned in the Pharmacopoeia. If you think that the cause of hemoptysis is dryness, and this happens most rarely, then known moisturizers are used, such as oils, milk of various animals and squeezed juices after taking general measures to divert matter in the opposite direction. Appropriate bloodletting and other treatment measures are used less and are weaker than what they do in other cases. When the cause is a blow to the liver, then they are treated with such powders. Prescription:  Chinese rhubarb - ten, Lacqua - five, Armenian clay - five; at one time they drink this in crushed form one and a half dirhams.

As for general medicines, then simple medicines are recorded in Book Two, in well-known headings. A medicine suitable for this case is a bloody one: if you grind it strongly, turning it into a kind of dust, and drink one miscal with something astringent or with squeezed juices, it brings the greatest benefit. If you chew on a purslane and swallow its juice, it sometimes delays hemoptysis immediately. The juice of a cucumber and its usar - squeezed juice, especially with something sticky and very astringent when it is swallowed little by little, as well as burnt deer horn, if mixed with other medicines, are very useful, like peppermint juice. Willow fruits in the amount of one dirham are also useful, coriander flowers - three dirhams with cold water; drink in the morning and evening.
  Corals also help a lot, as well as Samos clay. They say that in Greek it is called the "star of the earth"; it seems to be something other than talc. And one more thing: they take the blood of a kid until it has frozen, and they give it to drink half a day for three days in a row. They also give myrtle seeds or the seeds of the plantain large two dirhams in the infusion of the plantain large or in squeezed rose juice; this is extremely helpful. Quince is also healthy, especially toasted. They also give the kid’s rennet with rose water and other infusions, and they say also rabbit rennet and rennet of other animals with a decoction of ink nuts or with basil juice, especially breast

hemoptysis, or printed clay — Samosan clay — with a little vinegar — serves as its replacement.
  They also use sukutun - replaces the calendula. This is a survivor, but one person in the book he composed claims that it is a kind of basil growing between the rocks, and that it is rubbed and eaten with salt, and in Mosul it is supposedly called a wild mandrake or a wild apple. However, this is a moot point. This medicine is given with an equal amount of starch. One useful remedy against hemoptysis is to drink with Yemeni alum. They are extremely useful, especially with egg yolks, warmed up, but not quite thickened. And one more thing: fish glue also helps if you give it to drink. If the situation has become difficult, sometimes a quarter of the dirham of a bleached seed is given a drink with water sweetened with honey.
  It is necessary to drink with medicines that delay hemoptysis with tart wine, so that they pass better, unless, of course, there is a fever. When fever is watered with these medicines in some other squeezed juices.

With long-standing, chronic hemoptysis, the Nabataean leek seeds and myrtle seeds are used in equal amounts, up to two dirhams with squeezed juice of the “shepherd’s stick” are used in this medicine. Either they take the squeezed juice of the Syrian leek - one ukiyu, vinegar - half-kiyi and drink the patient in the morning, or drink it with a burnt sponge with a small amount of nabiz. Galen treated hemoptysis with teryak and mithridate, as well as medicines with a pleasant smell - they strengthen the nature in his desire to save blood and cover wounds, as well as “star” cakes and Andromache’s medicine. Centaury combines retention of hemoptysis and purification of the lung; febrile patients should be given to them with water, and the rest with wine. The Saclabs treat hemoptysis with a decoction of the centaury root.
  Of the medicines for drinking, they give squeezed juice of the big plantain - two dirhams, squeezed oxen juice - two dirhams, squeezed juice of portulaca gardena, squeezed juice of fresh rose stems, one ukiyu; they are pushed without spraying with water, and the juice is filtered, but not boiled, but a little printed clay is bred in it and given to drink.

Or they take squeezed juice from the stems of a rose and breed squeezed juice of hiufastidasa or blood and burnt deer horn in it and give them a drink. From cakes, cakes of this kind are used: they take equally Akaki, flowers of pomegranate, red rose, squeezed goat juice, peels of acorns, incense peels. And one more thing: they take arsenic, Luffah’s root bark, clay from Buheira6, frankincense, akakiyya, garden porcelain seeds, mountain basil seeds, pomegranate flowers, camphor and are made from all this flat cakes. Two dirhams are drunk at a time on half-water or tart wine or juice of a mountain basil. And one more thing: they take the seeds of sleeping pills, printed clay, frankincense and camphor and give them a drink with the juice of mountain basil. And they also give the cakes that Ibn Sarafiyun mentions; these are cakes made with almond tree gum. As for the oils used to lubricate the breast, in summer it is quince oil, and in winter - backgammon oil.
Great cakes:  they take clays from Buheira, coral, the “Samos star” and dry rose, each in two parts, amber, gum, starch - each in one part, mix and turn into flat cakes. Drink four miskals at a time - feverish - in astringent squeezed juices, and those who do not have a fever - in wine, especially in astringent wine.
  Common medicinal dressings include dressings with barley flour, crushed frankincense and acacia with egg white.
  When you stop the blood, then turn to wound healing and try to prevent the formation of a tumor. Wound healing is achieved with gluing and astringent medicines known to you; they prevent the onset of a tumor by inhibiting copious nutrition, diverting matter to the limbs and cooling the chest. The patient should swallow diluted vinegar several times; he should avoid the things mentioned above, also after the hemoptysis stops and the doctor turns to wound healing.

As for the water such patients drink, it should be rainwater or water in which Armenian clay or roses were soaked. Ferruginous water in which iron was quenched is very useful due to its astringent properties. If you can be afraid that the blood will thicken in the lungs, then the patient should be drunk at the beginning with vinegar diluted with water, unless there is a cough; then vinegar should beware. To dilute blood, sometimes half a dirham of turmeric and croton is prescribed with a certain amount of leek juice and a spoon of sikanjubin, and from complex medicines they give in this case: boiled fenugreek - two dirhams, aristolochia - dirhams, myrrh - three dirhams, kasatika oil - dirham, pepper black - one, bleached - one, rose - two dirhams. All this is turned into flat cakes, dried in the shade and allowed to drink with fennel juice. They also take rabbit rennet or water with fig ash and thyme, or sa tara with honey, or cause relaxation with emptying medicines from the number of simple medicines that we talked about in Book Two, and the complex medicines mentioned in the Pharmacopoeia. Read also our reasoning about the dissolution of frozen blood in Book Four.

In a child of 14 years old, in the period of the flu epidemic, by the 3rd day of illness, against the background of coughing and malaise, the temperature rose sharply to 40º, shortness of breath, hemoptysis appeared. Extensive bilateral shading (SaO2 84%) is detected on an X-ray of the lungs.

In blood tests: erythrocytes 1.9 * 10 12 per ml reduced, hemoglobin 75 g / l lower, platelets 60 * 10 3 lowering ml, white blood cells 1.5 * 10 9 per ml lower, s / I 1%, s / I 12% lymphocytes 60% increase, monocytes 27%.

What kind of disease is it. Influenza, a moderate form complicated by pneumonia.

What syndromes determine the severity of the patient's condition. temperature up to 40º, shortness of breath, hemoptysis

What is the emergency help.

Emergency Care for Hemoptysis

The patient needs to take a sitting position.

The treatment is aimed at stopping pulmonary bleeding, relieving chest pain and reducing the intensity of coughing.

The pain is removed by intramuscular injection of 1-2 ml of a 50% solution of dipyrone and simultaneously 1-2 ml of a 2.5% solution of pipolfen. Narcotic analgesics are administered only with intense pain.

At the same time, drugs that help stop bleeding are administered: 10 ml of a 10% solution of calcium chloride or calcium gluconate intravenously (calcium gluconate can be administered intramuscularly), 10 ml of a 10% solution of sodium chloride intravenously.

In the absence of thromboembolic complications, 1-2 ml of 1% solution of 20-30 ml of 10% gelatin solution is intramuscularly injected under the skin of the thigh (the solution is heated to body temperature before administration).

In case of persistent pulmonary hemorrhage that cannot be stopped with drugs, a transfusion of 50-250 ml of single-group blood is used, carefully checking compatibility.

In modern cardiorespiratory centers resort to embolization of bronchial vessels.

The threat of asphyxiation and the inability to perform an angiographic study followed by vascular embolization dictates the need for mechanical ventilation. In this case, the endotracheal tube is carried out into the unaffected bronchus.

They try to plug the bleeding site, minimizing blood aspiration. When hemoptysis of stagnant origin, patients with heart diseases are shown to apply tourniquets to the limbs in order to unload the pulmonary circulation and bloodletting.

With hemoptysis, arising in connection with the development of pulmonary infarction, therapy has some features. It is necessary to introduce up to 40000-50000 PIECES of fibrinolysin in 250 ml of isotonic sodium chloride solution intravenously dropwise and 15000 PIECES of heparin subcutaneously. In addition, broad-spectrum antibiotics and painkillers are introduced (1-2 ml of a 50% solution of analginum intramuscularly or 1 ml of a 2% solution of promedol subcutaneously). Cardiotonic agents (0.5-0.75 ml of a 0.05% solution of strophanthin or 1 ml of a 0.06% solution of corglycon in 20 ml of a 40% glucose solution intravenously) are used when symptoms of circulatory failure appear. With signs of acute left ventricular failure, administration of diuretics (40-80 mg of Lasix intravenously) and oxygen therapy are indicated.

Difficulty is the treatment of pulmonary hemorrhage that occurs with a shock lung. The development of DIC syndrome aggravates the condition of patients. It is necessary to carry out artificial ventilation of the lungs, transfusion of freshly frozen blood plasma up to 1 liter, the introduction of small doses of heparin (25-5000 units intravenously) and contracal up to 100,000 units.

Patients with hemoptysis, and especially with pulmonary hemorrhage, need immediate hospitalization, preferably to specialized pulmonary departments or thoracic surgical departments.

In a 9-year-old child, on the 7th day after a tick bite, the temperature rose to 39º, a headache, chills appeared. Around the site of the tick bite, annular redness appeared. A day later, against the background of high temperature, ring-shaped elements appeared on the face and chest. A maculopapular rash of a draining character on the rear of the arms and legs.

What disease should I think about? Tick-borne encephalitis

Necessary diagnostic measures?

Therapeutic tactics?

Ticks can be examined for the presence of tick-borne encephalitis. In this case, a person who has discovered a tick can extract it independently and bring it to the study. Prevention of encephalitis is carried out regardless of the results of a tick test for the presence of a pathogen.

Analysis of the history of the disease and complaints (time and order of occurrence of complaints, time and fact of a tick bite).

General examination (identification of manifestations of tick-borne encephalitis, its inherent symptoms).

Virological examination of blood and cerebrospinal fluid (virus isolation from saliva and / or human blood, its introduction into the body of laboratory animals, followed by detection of the virus in the tissues of their brain).

Determination of the virus and its particles in the blood and cerebrospinal fluid by PCR diagnostics (repeated reproduction of virus particles on special equipment allows you to accurately determine its type).

Determination of the level of antibodies (specific proteins of the immune system, the main function of which is the recognition of the pathogen (virus or bacteria) and its further elimination) in the blood by ELISA (enzyme-linked immunosorbent assay), RTGA (hemagglutination inhibition test).

Blood and cerebrospinal fluid tests are performed to determine the severity of damage to the nervous system and the nature of the disorders (general and biochemical blood tests, lumbar puncture and cerebrospinal fluid examination).

An infectious disease specialist consultation is also possible.

The most common causes of hemoptysis are: chronic and acute bronchitis, pulmonary tuberculosis, bronchiectasis, and lung cancer. In approximately 20% of patients, the provocative factor of this pathology cannot be established.

Today, with the appearance of hemoptysis syndrome, they resort to the following laboratory and instrumental studies: a detailed UAC (general blood test), a general urinalysis, a coagulogram (for suspected bleeding), a sputum test, a biochemical analysis (potassium, sodium, creatinine, urea), bronchoscopy, chest radiography, bronchography, and computed tomography of the chest.

Since pulmonary hemoptysis is a rather alarming symptom, it is necessary to approach the treatment of this pathology with maximum seriousness. As a rule, a small amount of blood at the time of coughing is not plentiful, and it stops on its own without any therapy. If the amount of blood released exceeds the permissible norm, then in such situations the treatment of hemoptysis is to provide emergency care.

The main elements of assistance with hemoptysis are: absolute calm of the patient, half-sitting position, patients are forbidden to speak, the health care provider must convince the patient to restrain cough and breathe deeply. In addition, help with hemoptysis includes the introduction of a 12.5% \u200b\u200bsolution of ethamzilate, 10% solution of calcium chloride or 5% solution of aminocaproic acid. During assistance with hemoptysis of a massive nature, a tray with pieces of ice should be near the patient. Every 15 minutes, the patient should be given one swallow.

As for the treatment of hemoptysis with non-traditional methods, it is aimed at eliminating the underlying disease, which provoked this symptom. The treatment of hemoptysis with folk remedies at the present time is a rather effective method, which requires mandatory consultation with a doctor. As symptomatic preparations, all hemostatic herbs can be used. The most common herbs for eliminating bloody pulmonary secretions are: chicory, yarrow, geranium root, nettle leaves, highlander, psyllium leaves, white nettle, snake highlander, three-leafed shift, common repost, medicinal hemorrhagic roots and field horsetail.

Etiology of the disease

Hemoptysis and the causes of its appearance require considerable attention of doctors, because the appearance of this symptom can greatly aggravate human health. In addition, blood after coughing indicates the presence of inflammation in the body or other ailment requiring urgent treatment.

The following diseases can cause hemoptysis:

• pulmonary infection (pneumonia, tuberculosis, pneumonia);
• hemoptysis can be a sign of an unpleasant pulmonary disease such as an abscess;
• this phenomenon is often observed with bronchitis;
• symptoms with blood secretion are the main ones in the development of a malignant neoplasm in the respiratory organs;
• the sign appears as a result of the development of heart failure;
• the course of idiopathic ailments;
• damage to the sternum also leads to a blood cough.

Also, the causes of hemoptysis are as follows - toxic components that adversely affect human health damage the integrity of the bronchi, thereby causing bleeding in this organ. Normal caustic smoke can cause hemoptysis.

In addition, hemoptysis is the main symptom of congenital diseases, such as:

• hemorrhagic disease;
• pulmonary vascular hypoplasia;
• cystic fibrosis.

An additional reason for the appearance of streaks of blood after a cough is a change in the composition of the blood that occurs at a pathological level. For example, it may be thrombocytopenia or an insufficient amount of certain substances.

Based on this, it is possible to compile a classification of the disease, namely:

1. The disease comes from inflammation.
2. From the development of a neoplasm that adversely affects the patient’s state of health.
3. From the injury he received.

What are the symptoms of hemoptysis

In order for the treatment to pass quickly and without complications for health, it is important to pay attention to the symptoms of pathology in a timely manner. Of course, if this symptom appears during the course of a dangerous disease (tuberculosis, pneumonia), the victim will soon notice its symptoms, and not only blood secretion when coughing.

Depending on the disease that caused the appearance of blood from the respiratory tract, the symptoms can vary significantly, however there are still several signs by which you can learn about the appearance of bleeding.

These include:

• possibly the release of foamy sputum, in which blood will be present;
• a constantly different shade of blood - from pale to scarlet;
• sometimes there is a “rusty” sputum, and if it is separated too often, its color will constantly saturate;
• the appearance of clots or streaks in the saliva;
• the appearance of dark blood, which indicates serious inflammation, as well as the absence of normal discharge from the pulmonary cavity (this is often observed in older people).

If a person has a development of a neoplasm, additional symptoms also include weight loss, excessive sweating, a strong cough, which can not be eliminated even after taking the medicine. These frequent symptoms, which are accompanied by a strong deterioration of the condition, should be taken with all responsibility, otherwise hemoptysis will cause unpleasant health consequences and complications.

In order to accurately identify the cause of this phenomenon, as well as treat the disease according to the correct scheme drawn up by the doctor, a number of diagnostic procedures should be carried out, which include:

• tomography;
• x-ray of the pulmonary cavity;
• sputum analysis;
• tracheobronchoscopy;
• full examination of the patient.

Also, treatment will not be prescribed to the patient until the doctor has a conversation with the patient, which will allow him to find out about his state of health, symptoms and possible causes of hemoptysis.

Treatment of hemoptysis and the disease that caused it

First aid for hemoptysis should be provided to a person during the development of this ailment. It can be provided at home, which will save the patient's life.

First aid during the development of hemoptysis is as follows:

1. Try to reassure the person. To do this, seat him and let him rest. At the same time, you don’t need to ask questions about his condition, because if anything, he will tell you what is bothering him.
2. Give the patient a drink of water.
3. Do not let the person talk and move.
4. Try to reclaim the victim while reclining.
5. To accelerate the removal of sputum from the lungs, it is recommended to put a compress on the patient's chest, which will cool the respiratory organs.

We must not forget that after assisting, even if a person feels normal, you still need to call a doctor.

In the hospital, pathology is treated with some drugs that can quickly alleviate the patient's condition. Hemoptysis is most often treated in a hospital, as the victim will need to undergo a rehabilitation course.

The treatment regimen in most cases looks like this:

• conducting hemostatic therapy, which restores the normal functionality of the respiratory organs;
• the use of Promedol, which is given with a strong cough or the development of bleeding in the lungs;
• intravenous administration of Codeine, which can stop the constantly appearing attacks;
• ingestion of antifibrinolytic drugs, which are prescribed depending on the course of the disease that caused hemoptysis;
• the introduction of intravenous solutions based on salt or colloidal liquid.

Quite often, for an early treatment of the disease, doctors prescribe non-traditional methods of treatment for patients - this is the use of certain drugs that help to remove phlegm and restore the normal functionality of the inflamed organ.

These include:

• chicory;
• yarrow;
• plantain;
• horsetail;
• geranium (flower root);
• nettle;
• highlander.

From these plants make infusions, teas and decoctions, which are taken along with medicines. It is important to note that to eliminate unpleasant symptoms accompanied by hemoptysis, it is unacceptable to use these herbs without a doctor’s prescription. Only he should name the list of allowed plants, and also teach them how to cook properly so that tea or infusion benefits the body.

Taking medications to treat hemoptysis without diagnosis is unacceptable. Otherwise, it can cause a large number of complications, the treatment of which does not always end successfully.

These unpleasant health effects include:

1. Cancer of the affected respiratory organ.
2. Hemosiderosis of the lung cavity.
3. The reduction of the respiratory organ in size.

Unfortunately, not all diseases that cause such an unpleasant symptom as hemoptysis are treated quickly and completely. Some of them can be unsuccessfully treated for years or just maintain the general condition of the body.

How is pulmonary disease prevented?

In order for hemoptysis to never overtake a person, he is advised to carry out some preventive measures that will help in time to remove sputum from the lungs. During the treatment of the disease, it is also recommended that they be adhered to, so that sputum with an admixture of blood and its veins quickly leaves the airways.

To begin with, it should be noted that it is important to treat all diseases of the heart and lungs in time, as well as to heal neoplasms that can greatly change the state of the body.

• stop drinking strong drinks, especially if they consume them in large quantities;
• try to spend more time outdoors, where the air is clean and fresh;
• it is not recommended to smoke a lot (if possible, give up this habit, which greatly aggravates the condition of the lungs);
• eat healthy food, which will not contain chemical components, dyes and preservatives.

As you can see, these factors can greatly harm human health, so you need to get rid of them quickly. Many doctors (and not only pulmonologists) advise patients to reconsider their lifestyle, as it can harm the state of health.

Pulmonary causes of hemoptysis

Isolation with a cough of a large amount of blood (more than 100 ml per day) is called pulmonary hemorrhage. With a loss of 600-800 ml of blood within 24 hours, there is a threat to life due to blood aspiration and asphyxiation. However, the division into hemoptysis and pulmonary hemorrhage is relative. Any hemoptysis is a symptom of an emergency, as one can never say with certainty that after a slight hemoptysis, there will not be profuse pulmonary hemorrhage. The source of bleeding can be vessels of the pulmonary artery system or bronchial vessels.

The provoking factors of the disease can serve:

atmospheric pressure reduction,

infection,

insolation.

Hemoptysis can occur with a variety of lung diseases, including inflammatory (bronchitis, bronchiectasis, pneumonia, lung abscess, tuberculosis), neoplasms (lung cancer, bronchial adenoma), heart and vascular diseases (mitral stenosis, pulmonary embolism, aortic aneurysm), chest injuries, autoimmune diseases (Goodpasture syndrome, Wegener's granulomatosis).

Hemoptysis is observed in diseases of the lungs, accompanied by the collapse of the lung tissue, with involvement of the pulmonary vessels in the decay zone, impaired integrity of the vascular wall. In this case, the amount of bleeding largely depends on the caliber of the damaged vessel.

Tuberculosis - as a provoking factor in hemoptysis

Among lung diseases, tuberculosis remains one of the common causes of hemoptysis to date. Hemoptysis can complicate any form of pulmonary tuberculosis: an infiltrative outbreak, hematogenous dissemination, fibrocavernous process. It should be borne in mind that sometimes hemoptysis is the first noticeable symptom of tuberculosis for a patient. Usually it is not plentiful and life-threatening, but we must always remember the possibility of fatal bleeding.

Anamnestic data help in the diagnosis of tuberculosis: the presence of pulmonary tuberculosis in the past, symptoms of exacerbation of the process and tuberculous intoxication - fever, night sweat, weight loss, increased fatigue, debilitating cough.

Non-tuberculosis causes of coughing up blood

The most common cause of the disease is non-tuberculous suppurative lung disease, and among them primarily bronchiectasis and lung abscess. Changes in the structure of pulmonary diseases and a decrease in the specific gravity of tuberculosis have led to the fact that in recent decades bronchitis and bronchiectasis have come first, causing almost half of all cases of hemoptysis. Bleeding with bronchiectasis and abscesses is usually mild, but has a tendency to frequent repetitions, especially during periods of exacerbation of the chronic suppurative process. Long-term cough, a large amount of sputum, especially in the morning (full mouth), changes in the nail phalanges of the fingers in the form of “drumsticks” or nails in the form of “watch glasses”, percussion and auscultatory signs of pulmonary emphysema and pneumosclerosis reliably help in the diagnosis of bronchiectasis as the cause hemoptysis.

An admixture of blood to the mucous sputum or the excretion of pure blood with a cough is often noted in the acute period of pneumonia (especially viral influenza). In these cases, hemoptysis is combined with chills, fever, often shortness of breath, chest pain when breathing. An objective study reveals a shortening of percussion sound and wet rales in the area of \u200b\u200binflammation.

Isolation of blood with a cough is a common symptom of a lung tumor. About a quarter of all hemoptysis cases are caused by benign and malignant lung tumors. An admixture of blood to sputum gives the latter a look of raspberry jelly. It should be emphasized that hemoptysis and nagging debilitating cough may be early and for some time the only complaints of a patient with lung cancer. In these cases, the success of subsequent surgical treatment often depends on how soon after the cough and hemoptysis the patient was referred for an X-ray examination and a lung cancer diagnosis was established.

Cardiological causes of hemoptysis

In addition to lung diseases, blood in the sputum can occur with heart diseases, accompanied by stagnation of blood in the pulmonary circulation, especially with narrowing of the left venous opening - mitral stenosis. Hemoptysis in this case is scarlet blood, in the form of veins, usually not very profuse, after which shortness of breath sometimes decreases and patients' well-being improves.

Anamnestic information about rheumatism and heart disease, the patient’s characteristic appearance with mitral defect (acrocyanosis, “mitral blush”), objective study of the heart (expanding the borders of the heart up and to the right, popping I tone and diastolic murmur at the apex, opening click) help to find out the cause of the phenomenon. mitral valve, accent and bifurcation of II tone on the pulmonary artery, usually atrial fibrillation). The appointment of patients with hemoptysis with mitral stenosis of the appropriate cardiac and diuretics usually significantly improves the condition and leads to a significant reduction or cessation of hemoptysis.

The disease can be caused by stagnation in the vessels of the pulmonary circulation due to acute and subacute insufficiency of the left ventricle of the heart in patients with hypertension, atherosclerotic cardiosclerosis, myocardial infarction. Typically, hemoptysis in these patients is preceded by an attack of cardiac asthma, or shortness of breath increases so sharply that patients can not lie and are forced to sit for days on end, lowering their legs. Hemoptysis is not abundant. First, patients cough up spitting red blood, which gradually darkens as hemoptysis decreases. A repeated attack of suffocation can lead to a relapse of hemoptysis, i.e. hemoptysis appears with an increase in left heart ventricular failure and increased stagnation of the lungs. Effective cardiotonic and diuretic therapy in these patients usually leads to the cessation of hemoptysis, together with an improvement in the condition, a decrease in shortness of breath and stagnation of the lungs.

Rare Causes of Developing Hemoptysis: Pulmonary Infarction, Aneurysm, and Trauma

A relatively rare cause of pulmonary hemorrhage is a breakthrough of the aortic aneurysm in the bronchus. Bleeding usually leads to instant death. However, sudden bleeding is sometimes preceded by a so-called prognostic hemoptysis, caused both by compression of the bronchial mucosa and leakage of small amounts of blood through the thinned wall of the aneurysm in the bronchus, over several days or weeks.

One of the causes of hemoptysis is pulmonary infarction. In this case, hemoptysis is combined with sudden shortness of breath, chest pain, fever. Anamnestic information and examination data make it possible to detect pathology of the heart and blood vessels (heart disease or cardiosclerosis with atrial fibrillation, vein thrombosis of the lower extremities), signs of an overload of the right heart are detected on the ECG.

The disease can be observed with chest injuries, accompanied by hemorrhage in the lung tissue, sometimes even in the absence of visible damage to the skin and violation of the integrity of the ribs. The cause of the phenomenon may be foreign bodies that have fallen into the lungs with old wounds or aspirated into the bronchi. In these cases, hemoptysis is caused by the breakdown of the lung tissue as a result of the formation of a pressure sore from a foreign body, reactive inflammation and atelectasis.

Diagnostic signs of hemoptysis

Diagnosis, as a rule, is not difficult. It is never in a dream, since a cough wakes the patient. Blood with pulmonary hemorrhage is always excreted with a cough, usually has a scarlet color, foamy. In rare cases, difficulties arise in the differential diagnosis between pulmonary and gastric bleeding, especially if the patient swallowed part of the blood with pulmonary hemorrhage and subsequently there was bloody vomiting. The following is a comparative description of gastric and pulmonary hemorrhage (Table 1).

Table 1

Differential diagnosis of hemoptysis symptoms for pulmonary and gastric bleeding

Clinical data	Gastric hemoptysis	Pulmonary hemoptysis
	Diseases of the liver and stomach, dyspepsia	Lung diseases
Bleeding conditions	Vomiting blood	Coughing up blood, hemoptysis
The nature of the blood	Dark blood, clots, "coffee grounds"	Scarlet blood, almost not clotted, foamy
	In addition to blood, vomit may contain food debris	Blood may cough with sputum
Hemoptysis Duration	Bloody vomiting, usually short-term and profuse	Hemoptysis lasts several hours, sometimes several days
The subsequent symptoms of hemoptysis	There is no subsequent hemoptysis	After profuse hemoptysis, coughing up spitting gradually darkening blood
Chair character	After gastric bleeding, the stool becomes tarry	A tarry stool, if there was no swallowing of blood, no

Features of hemoptysis treatment

The basic principles of treatment tactics for pulmonary hemorrhage:

As a rule, hemoptysis is not abundant and stops on its own without special therapy. It is necessary to minimize the conversation with the patient and give him an elevated, semi-sitting position or a lying position on the sore side to prevent blood from entering the other lung. Swallowing small pieces of ice helps to reduce the symptoms of the disease. Bleeding, especially the first to occur, usually scares the patient and others, so you need to reassure the patient if possible. However, sedatives are used with great caution, since they can reduce protective reflexes and mask increasing respiratory failure; Especially dangerous are tranquilizers with a muscle relaxant effect (including the diaphragm).

After emergency care, the patient is subject to mandatory hospitalization. Transportation should be carried out on a stretcher with a raised head on the ambulance in the presence of a doctor or paramedic. It is only in a hospital setting that the full range of treatment measures aimed at stopping pulmonary hemorrhage and a more detailed examination to determine its cause are possible. In particular, patients need urgent consultation with a pulmonary surgeon, since cavernous tuberculosis, anaerobic abscess and lung cancer are indications for surgical treatment. If it is known that the patient suffers from tuberculosis, with hemoptysis he should not be sent to general hospitals, but to specialized anti-tuberculosis institutions.

The main goal of drug treatment is to suppress the arising cough, which can aggravate the severity of the patient's condition. For this, in the hospital, codeine is used, which is prescribed inside; with persistent excruciating cough and heavy pulmonary hemorrhage, 0.5 - 1 ml of a 2% solution of Promedol is administered intravenously or subcutaneously as emergency therapy (narcotic analgesics effectively suppress the cough center). However, opiates should not be abused, since the complete suppression of the cough reflex can lead to aspiration of the spilled blood and the development of severe aspiration pneumonia.

With abundant, life-threatening pulmonary hemorrhage, not associated with pulmonary embolism or other cardiovascular pathology, hemostatic therapy is performed in the hospital. Antifibrinolytic agents for the treatment of hemoptysis can be effective in the presence of a local increase in fibrinolysis: Aminocaproic acid is administered intravenously - up to 100 ml of a 5% solution for 30 minutes and then the infusion is repeated every 4 hours until the bleeding stops; tranexamic acid - intravenously or intramuscularly in a dose of 5 - 10 ml (1 - 2 ampoules) of a 5% solution; in addition, transfusion of freshly frozen plasma is effective.

With massive hemoptysis and the appearance of symptoms of hypovolemia, colloid (for example, 400 ml of Polyglukin) or saline solutions (however, they may need 4 times as much as colloid ones) are administered intravenously to replenish the volume of circulating blood.

An admixture of blood for expectorated sputum, or hemoptysis, usually requires an in-depth examination. This symptom can be associated with infectious lung damage, vascular pathology, malignant tumors of the respiratory system and other diseases.

There are many diseases that can potentially cause hemoptysis. The most common of them:

•   or bronchitis;
•   or a benign tumor of this organ, cancer of the bronchi, metastases in the lung tissue;
• prolonged use of anticoagulants (drugs that worsen blood coagulation, for example, warfarin);
• diseases with normal coagulation (coagulopathy) - von Willebrandt disease, thrombocytopenia, hemophilia;
•   or ;
•   echinococcosis;
•   or its small branches;
• heart failure, especially with mitral stenosis (a variety of heart disease);
• many systemic diseases (lupus erythematosus, Wegener's granulomatosis, Charge-Strauss syndrome, polyangiitis, Behcet’s disease and others);
• arteriovenous malformations - congenital malformations of blood vessels;
• chest injuries, bruised lung;
• the first days after operations on the respiratory organs, including after a biopsy;
• cocaine use;
• lymphangioliomyomatosis;
• endometriosis;

Hemoptysis may be a consequence of the release of blood from extrapulmonary sources. For example, with severe nosebleeds or vomiting of blood with a stomach ulcer, part of it may fall into the trachea, and then appear when coughing.
In some patients, the cause remains unknown, while the duration of complaints does not exceed six months, and then this symptom disappears spontaneously. This condition is called idiopathic, or cryptogenic hemoptysis.

Blood in sputum can be streaked or more evenly distributed. In classic cases of croupous pneumonia, “sputum” sputum is observed. With lung cancer, it takes the form of "raspberry jelly."

Features of hemoptysis in various diseases

The most dangerous disease is lung cancer

Diseases of a different nature have hemoptysis features:

• Acute or chronic bronchitis: small streaks of blood in light, yellow, or greenish sputum. They appear with a dry cough.
• Bronchiectasis: a lot of sputum, it has a purulent character. Congenital bronchiectasis is a common cause of hemoptysis in children. With the so-called dry bronchiectasis, such recurrent episodes may be the only sign of pathology for many years.
• Tuberculosis: hemoptysis often occurs with a disease with the formation of lung cavities. A persistent, purulent sputum with bloody veins is characteristic. The patient feels constant weakness, loses weight, sweats heavily at night.
• Pneumonia: with pneumococcal pneumonia, a significant number of patients develop "rusty" sputum. If it has the appearance of "currant jelly", we are talking about pneumonia caused by Klebsiella. Hemoptysis is also characteristic of pneumonia with the breakdown of lung tissue (caused by staphylococcus, legionella, Pseudomonas aeruginosa).
• Lung abscess: purulent sputum, green to brown in color, fever. Bloody streaks appear in 10% of patients, later half of these patients develop pulmonary hemorrhage, a life-threatening complication.
• Fungal affection. Hemoptysis can be almost the only sign of mycetoma, or aspergilloma. This disease is caused by the multiplication of fungi in old tuberculous cavities.
• Lung cancer: prolonged cough with light sputum, in which there are streaks of blood, weight loss.
• Bronchial adenoma: occurs mainly in women 35 to 45 years of age, almost the only symptom of pathology is coughing and repeated episodes of hemoptysis.
•   increase in pressure in the pulmonary artery system, accompanied by rupture of the smallest vessels. It is observed with mitral stenosis, congenital heart defects with the formation of Eisenmenger syndrome, primary pulmonary hypertension. Symptoms occur after exercise.
• Pulmonary infarction: a violation of its blood supply during thromboembolism of the branches of the pulmonary artery. There is an increase in temperature, as well as the release of blood clots that are not mixed with sputum.

Other causes of hemoptysis are less common and less recognized. In children, this symptom sometimes occurs when a foreign body is inhaled. Wegener's granulomatosis is characterized by concomitant ulcerative lesions of the walls of the nose, skin rash and nodules, and gum disease. Arteriovenous malformation can be accompanied by manifestations of pathology in other places, then cyanosis, swelling, increased vascular pattern, or vasodilation occurs in limited areas of the skin. Endometriosis of the lungs is accompanied by bloody discharge from the respiratory tract during menstruation.

Diagnostics

If such a symptom occurs, you should consult a therapist who will refer the patient to a pulmonologist, rheumatologist, gastroenterologist or other relevant specialists, depending on the alleged disease.

Bronchoscopy

After collecting complaints, questioning, examining the patient, the doctor prescribes such studies:

• general blood count with determination of platelet count, as well as a coagulogram;
• blood biochemistry with determination of liver and kidney function indicators (bilirubin, ALT, AST, alkaline phosphatase, urea, creatinine);
• microbiological for the detection of causative agents of pneumonia, tuberculosis and other infectious lesions;
• cytological analysis of sputum to detect malignant (atypical) cells in smoking patients older than 40 years;
•   (congestion in the lungs, etc.);
•   (a detailed image of the structures of the chest, especially useful for bronchiectasis, small tumors, fungal infections);
• tomography with contrast to identify the source of bleeding;
•   (examination of the respiratory tract using a flexible optical fiber).

Pulse oximetry and analysis of the arterial gas composition are used to determine the severity resulting from bleeding.

Other research methods may be used:

• ECG and echocardiography for suspected heart disease or pulmonary embolism;
• angiography;
• FGDS.

Hemoptysis: treatment

The treatment is aimed at stopping the bleeding and eliminating its source.

Embolization of the bronchial artery: before and after the procedure

Possible methods for treating hemoptysis:

• Embolization of the bronchial artery. This is a minimally invasive intervention, during which a thin catheter is inserted through the femoral vein and the right chambers of the heart into the pulmonary artery. A dye is introduced through it, and with the help of a bronchoscope, the place of damage is determined, which then overlaps.
• Bronchoscopy In stopping the bleeding, a balloon inserted into the lumen of the bronchus and filled with air can help.
• If life-threatening, removal of the lung may be required - pulmonectomy.

Of the drugs used:

• with pneumonia or tuberculosis - antibiotics;
• with lung cancer, chemotherapeutic agents;
• with systemic inflammatory diseases - glucocorticoids, immunosuppressants;
• hemostatic agents - ethamylate, fibrinogen, less commonly - aminocaproic acid and others, but only with intense bleeding.

The most common cause of hemoptysis is. With this disease, they are prescribed that soften the cough, improve sputum discharge and cause the cessation of blood flow in less than a week. However, blood in the sputum can be a sign of a serious illness. It is necessary to consult a doctor with such symptoms:

• the duration of detection of blood in sputum for more than a week, a gradual increase in its amount, as well as the repeated appearance of a symptom
•   , including during coughing and deep breathing;
• unexplained weight loss;
• sweating at night;
• an increase in body temperature over 38 degrees;
•   with normal physical activity for a person;
• sudden appearance of scarlet foamy blood from the mouth - pulmonary hemorrhage.

Diagnosis and treatment of diseases - the causes of hemoptysis is usually carried out in a hospital. If hospitalization is not required, the patient should observe a half-bed regimen, spending most of the time in a reclining position. Any thermal procedures are prohibited. It is recommended to give food a cold, semi-liquid consistency, easily digestible.