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Massive Hemoptysis

UnFiNiShEd CaSe CoMe BaCk LaTeR

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

History of Present Illness:

A 32-year-old female presents to the ED for hemoptysis during the COVID19 pandemic.  She is choking and coughing up blood in front of you and cannot speak.  Her boyfriend said she was recently treated for a “bloodstream infection”.  She is in extremis and requires immediate intubation.  Before you get a chance she codes

Vital Signs & Physical Exam:

Bradycardic.  Blood pouring from mouth with each cough

Initial Differential Diagnosis: 

  • GI bleed
  • TB or other cavitary pneumonia
  • diffuse alveolar hemorrhage

Relevant Test Results:

  • EKG: none
  • Labs: none ordered
  • Imaging: nCXR

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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ANSWERS:

  1. What does the case image show?  The image shows bilateral mild infiltrates.  She had a prior CT showing bilateral cavitary pneumonia.
  2. What should you do next?  Intubate good lung if possible
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

CLICK HERE TO LEAR MORE ABOUT THIS BOOK

CASE CONCLUSION: Massive hemoptysis from cavitary pneumonia from tricuspid valve endocarditis from heroin abuse.  She died.

CASE LESSONS:

  1. Try to avoid lying flat.  Position with bad bleeding lung down.  If unsure guess and reassess.
  2. Avoid blood and fluids unless in shock.  hypotensive resuscitation may minimize bleeding
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