Today the VA reviewed a case of a young patient (35) presenting with hemoptysis. Our residents broke things down into a few main triage questions to start off with:
- How much blood is coming out?
- Is the patient able to cough it up on their own? What’s their respiratory status?
- What’s the patient’s hemodynamic status?
These questions will help you get a sense of how severe the patient’s condition is, because hemoptysis can range from totally benign to immediately life-threatening. If this person needs to go to the ICU, be intubated, or even have CT surgery called, we need to know as soon as possible!
Once it was revealed that this patient was stable and able to expectorate their blood without significant distress, the teams shifted to differential. 90% of significant hemoptysis is due to bronchial arterial bleeds, and bleeding can occur in the airway itself, parenchyma, or even as a result of vascular dysfunction or defects.