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