HEMOPTYSIS

Etiology:

  1. Lung: Bronchitis, pneumonia (CAP, TB), CA, CF, Collagen-Vascular, Violent cough
     
  2. CV: PE, CHF, Aortic aneurysm, MS,
     
  3. Other: Epistaxsis and GI bleed can be erroneously described by the pt as "I'm coughing blood".

S & S:

  1. This will depend on quantity of  blood lost, respiratory compromise, and the underlying cause.

DX:

  1. R/O gastric source by NG tube lavage or pH (acidic  when GI origin).
     
  2. Cxray, ABG, CBC, PT/PTT, sputum gram stain, CT (prn if aortic aneurysm is suspected), EKG, V/Q (prn), bronchoscopy (prn), ECHO/TEE (prn).

Treatment:

  1. Minor hemoptysis (blood streaked sputum) usually requires only cough suppressants and/or antbx. Diagnostic w/u is dictated by pt's history and physical exam. Proper F/U must be provided.
     
  2. Major hemoptysis in ER requires ABCs to be the main goal. This could consist of  maintaining patent the airways, intubation, O2, blood transfusion. If  bleeding side is known pt should be positioned on that side to decrease chance of aspiration into other lung. Cough suppressant and humidified air are helpful.
     
  3. Once pt is stabilized, pulmonary and/or surgical consult must be  obtained for bronchoscopy and, if needed, pt should go to OR if the problem is cardiothoracic.
     
  4. All patients with major hemoptysis should be admitted to the ICU, as sudden worsening of bleeding may cause rapid decompensation.

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