Pediatric emergency medicine trisk 2797 2797

FIGURE 99.4 Idiopathic pulmonary hemosiderosis. A 5-year-old child with repeated bouts of
pulmonary hemorrhage. The chest film shows diffuse radiopacities throughout both lungs (more
on right side), with a well-defined alveolar opacity in the right lower lobe. Note the surgical
sutures in left upper lobe.

Management
Immediate management of any patient with presumed pulmonary hemorrhage is
supportive. Supplemental oxygen to correct hypoxemia and intravascular volume
repletion should be initiated. For those with chronic disease or large acute blood
losses with resultant anemia, anticipating the need for blood transfusions is
important. Occasionally, pulmonary hemorrhage is so severe that it causes
respiratory insufficiency or hypotension due to hemorrhagic shock.
Aggressive fluid resuscitation followed by positive-pressure ventilation with
PEEP is the preferred treatment in this situation. In these severe cases, platelets
and fresh-frozen plasma can also provide volume replacement and help with
hemostasis.
Bronchoscopy can be diagnostically useful, usually to determine infectious
causes rather than to localize a source of bleeding and control it, which can be