MedBugs: SAQ #388

Case: Massive haemoptysis

A 69-year-old woman presents with a 1-hour history of haemoptysis, coughing up approximately two cups of bright red blood. She has a history of breast cancer with right mastectomy and is on apixaban for paroxysmal atrial fibrillation. Her observations are : T 37.5 HR 100 BP 110/80 RR 28 Sats 92% RA

1. State a definition for massive haemoptysis. 1 mark

2. List your top three differential diagnoses in this patient. 3 marks

She has ongoing haemoptysis and a decision is made to reverse her anticoagulation.

3. Give two medications including dose and route that can be given to reverse anticoagulation. 2 marks

4. List (3) investigations that would assist in your management and provide justification for each. 3 marks

The patient continues to deteriorate with ongoing large volume haemoptysis despite your management. She is in your resus bay attached to full non-invasive monitoring and has peripheral IV access. Saturations have dropped to 90% on 15L/min via NRB.

5. State (3) modifications to your standard approach to RSI 3 marks

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