Hemoptysis

Question 1

Essentials of Diagnosis:

Fever, cough, along with other symptoms of the lower respiratory tract
Smoking history
Nasopharyngeal or GI Bleed due to NSAIDS
* Chest Radiography and CBC shows blood

Answer 1

Hemoptysis

Question 2

Dx:

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

as either >500 mL of expectorated blood over a 24-hour period or bleeding at a rate >100 mL/hour.

Answer 3

Massive hemoptysis

Question 4

Physical Findings:

Tachycardia
Hypotension
Decreased oxygen saturation
Inspect nose and oropharynx
Bruits
Needles Tracks
Murmur
Blood in nose
Clubbing or cancers
Asymmetric lower extremity swelling

Answer 4

Hemoptysis

Question 5

Lab/Imaging:

CBC - hemoglobin and hematocrit

The most important initial study, beyond history and physical examination, for all patients presenting is a chest radiograph followed by chest CT at earliest convenience

Answer 5

Hemoptysis

Question 6

Differential Diagnosis:

Tuberculosis
Chronic Bronchitis
Pneumonia
Pulmonary AVM

Answer 6

Hemoptysis

Question 7

Treatment:

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

Position the patient with the presumed bleeding lung in the dependent position. Purpose is to protect nonbleeding lung since spillage of blood into the nonbleeding lung could affect gas exchange.

Establish airway: patient with signs of respiratory distress should be intubated.

Answer 7

Hemoptysis