Hemoptysis
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 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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