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Hemoptysis

  • Common ddx

    • pneumonia, bronchiectasis, CHF, coagulopathy
  • Serious ddx

    • lung cancer, TB, PE
  • Labs

    • CBC, chem
    • coags
    • UA
    • CXR
    • ddimer, CT if PE
    • ANCA, autoantibodies panel if suspect autoimmune
    • echo if valvular disease
  • ED Tx (ABCs)

    • O2
    • intubation if needed
    • NS IV
    • typed and cross if transfusion needed
    • FFP if coagulopathy or on warfarin; platelets for thrombocytopenia
    • Hydrocodone 5-15 mg q 4-6 hours for cough suppression
    • decubitus position to avoid aspiration
    • pulm or thracic surgeon consult
    • D/C on cough suppressants, albuterol prn
  • Pulm ddx

    • lung cancer, TB, pneumonia, PE, CF, bronchiectasis, telangiectasia, AV fistula, bronchitis, foreign body, bronchus injury (trauma or iatrogenic)
  • Cardio ddx

    • CHF, mitral stenosis, pulmonic stenosis
  • Hemonc ddx

    • coagulopathy, hemophilia, vWD, leukemia, thrombocytopenia
  • Autoimmune

    • Goodpasture's, Wegener's, lupus, sarcoidosis
  • Gyn

    • pulm endometriosis
  • HPI

    • onset
    • quality: frank blood vs streaks vs pink sputum
    • quantity
    • triggering events
  • ROS

    • hemoptysis (cough) vs hematemesis (vomit)
    • fever, weight loss, nightsweats
    • cardiopulm: chest pain, palpitations, dyspnea, exertional dyspnea
    • frequent infections
    • easy bleeding
    • recent bronchoscopy
  • PMH

    • COPD
    • CF
    • bleeding disorders
    • immunosuppression, HIV
    • previous thoracic surgeries (fistula risk)
  • FH

    • coagulopathy
    • CF
  • SH

    • smoking hx
    • foreign travel
  • Meds

    • anticoagulation
  • Allergies

  • Px

    • skin: bruising, rash
    • cardio: murmurs
    • pulm
    • abd: organomegaly
    • ext: peripheral edema
    • lymphadenopathy

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.