13. Emergency conditions in pulmonary tuberculosis

13.1. Pulmonary bleeding

In patients with tuberculosis, pulmonary hemorrhages often occur in fibrous-cavernous, cirrhotic, and infiltrative tuberculosis, as well as in primary tuberculosis with the presence of lymphobronchial fistulas. Sometimes bleeding occurs in post-tuberculosis pneumosclerosis. Profuse pulmonary hemorrhages pose a great danger to life and result in fatal outcomes in 20–25% of cases. In pulmonary hemorrhage, unlike bleeding from the esophagus or stomach, blood is always coughed up. Bright red blood originates from the bronchial arteries, while dark blood originates from the pulmonary artery system. The reactions in pulmonary hemorrhage are neutral or alkaline, while from the vessels of the digestive tract it has an acidic reaction.

The pathogenesis of pulmonary hemorrhage is complex and is determined by a number of factors. The most important of them are:

1. violation of the permeability of the vascular wall;
2. violation of the integrity of the vessels;
3. hypertension in the pulmonary circulation;
4. violation of blood coagulation processes.

The danger of pulmonary hemorrhage is associated not so much with blood loss as with complications of aspiration pneumonia, atelectasis, asphyxia.

Urgent care:

1. the fight against asphyxia (semi-sitting position, suction of blood with a catheter, pulmonary bronchoscopy). To create a depot, soft tourniquets should be applied to the limbs;
2. lowering of pulmonary pressure (Gangleron 1.5% 1–2 ml SQ, Pentamine 5% 1–2 ml SQ, Benzohexonium 0.1 orally 2–3 times a day, Pyrilene 0.01 3 times a day day, Nitroprusside, Arfo-nad). The maximum arterial pressure should not be lower than 90 mm Hg;
3. fibrinolysis inhibitors [aminocaproic acid 5% 100.0 IV drip. Kontrykal 10–20 thousand ATU in 100 ml of 0.85% sodium chloride solution IV for 5–7 minutes (slowly)];
4. elimination of increased permeability of the vascular wall (Calcium chloride 10% IV 10.0 or Sodium chloride, Calcium gluconate, Ascorbic acid, Haloscorbin, Vikasol IM 1.0–1.5 ml 1%, vitamins).

In cases of hemoptysis, the following is recommended: fibrinolysis inhibitors — aminocaproic acid orally at 5 g 3–4 times a day. Measures aimed at eliminating increased permeability of the vascular wall. Two to three days of semi-bed rest. If there are symptoms of aspiration pneumonia, non-specific therapy is prescribed. It is necessary to avoid prescribing medicinal and cough suppressants, as complete suppression of the cough can contribute to the development of aspiration pneumonia.