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EM Clerkship

Hemoptysis

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9816 Ratings

🗓️ 18 June 2017

⏱️ 9 minutes

🧾️ Download transcript

Summary


There are 3 main “categories” of hemoptysis…



Mild, “Streaky” Hemoptysis



* Most common diagnosis* Bronchitis* Testing plan* Chest xray* Rules out alternative causes of hemoptysis* Pneumonia* Cancer* Pulmonary Embolism* Vasculitis



Scary but Stable Hemoptysis



* Patient is coughing up frank blood* Testing plan* CTA of the chest* CBC* PTT/PT/INR* Electrolytes* Need renal function if giving IV contrast



Oh-My-God-That’s-A-Lot-Of-Blood!!!



* Intubate the patient* Consult cardiothoracic surgery/interventional radiology



Additional Reading



* Hemoptysis: An EM Primer (emDOCs)

Transcript

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0:00.0

Hello, med students.

0:02.0

My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship Podcast.

0:11.4

We have a good one this week.

0:13.1

Here's your case.

0:25.0

Okay, we have a 57-year-old females come from home.

0:30.2

Chief Complaints are going to be coughing up blood for the last, I guess, from this morning anyway, coughing in the amails the whole time, so history is just a little bit boggy.

0:34.3

She says she's been sick times when we, possibly on O2 regularly. We saw it in the

0:38.6

room, but unknown for what? BP 120 over 80, pulse of 94, respirations are 20. We have a bag of meds.

0:45.9

Anybody have any questions? I know that wasn't a whole lot. Oh, yeah, so we didn't see any blood

0:52.3

or kind of how much or anything, but maybe like a small pile of tissues.

0:56.5

So anything else?

0:59.7

Okay, thank you.

1:03.3

Not very specific, right?

1:05.0

But that's kind of how emergency medicine is, but this is hemoptosis, coughing up blood. This is emergency medicine 101. It's not a core

1:14.1

complaint necessarily. You might only get one or two of these when you're rotating, but as always,

1:20.5

my goal is to help you sound smart so that you can get those top one-third scores on your slow.

1:28.3

And the way to sound smart is to know an approach to these less common complaints that

1:33.3

are still common enough to make it worth your time to study.

1:39.3

Today, what I want you to remember are the three types of homopatosis. If you read the textbooks, there's actually

1:47.7

only two official categories, which they call massive in minor hemoptosis. And they have these

1:53.8

arbitrary definitions like, if your patient coughs up more than 100 mls or 200 mls of blood,

2:00.0

that's massive hemoptosis. I don't like that definition

...

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