Hemoptysis

Question 1

what are the essentials of Diagnosis for hemoptisis?

Answer 1

(1) Fever, cough, along with other symptoms of the lower respiratory tract
(2) Smoking history
(3) Nasopharyngeal or GI Bleed
(4) Chest Radiography and CBC

Question 2

_______ or the expectoration of blood, can range from blood-streaking of sputum to
the presence of gross blood from below the vocal cords or within the lungs.

Answer 2

Hemoptysis

Question 3

______ is reserved for bleeding that acutely life threatening 100 mL to 600 mL within a 24 hour period.

Answer 3

Massive hemoptysis

Question 4

What labs/rads would you order for pt with suspected hemoptysis

Answer 4

CBC

CXR followed by a CT scan

Question 5

What are some DDxs to consider for Hemoptysis

Answer 5

(1) Tuberculosis
(2) Chronic Bronchitis
(3) Pneumonia
(4) Pulmonary AVM

Question 6

initial steps in managing a patient with massive hemoptysis are to

Answer 6

• ensure adequate oxygenation

- determine if the bleeding is coming primarily from one lung and, if so, which side is the primary source.

Question 7

How should you position a patient with massive hemoptysis

Answer 7

-immediately placed into a position in which the presumed bleeding lung is in the dependent position

Question 8

What is the purpose of proper positioning of a patient with massive hemoptysis?

Answer 8

To protect the nonbleeding lung, since spillage of blood into the nonbleeding lung may prevent gas exchange by blocking the airway with clot or filling the alveoli with blood.

Question 9

True/False
Patients with massive hemoptysis who have
significant shortness of breath, poor gas exchange, hemodynamic instability, or rapid ongoing hemoptysis should be intubated with a large bore endotracheal tube

Answer 9

True

Question 10

What size should you give for intubating a massive hemoptysis

Answer 10

size 8 or greater, if possible

Question 11

What are the possible complications of hemoptysis

Answer 11

(1) Death
(2) Referred to a pulmonologist
(3) If upper respiratory tract then refer to an otolaryngologist (ENT)

Question 12

What type of meds should you give for hemoptysis

Answer 12

Meds to treat underlying illness

Question 13

What are the important parts of a CBC to consider when treating hemoptysis

Answer 13

• hemoglobin and hematocrit (to assess the magnitude and chronicity of bleeding),
• white blood cell count and differential (evidence for infection)