MedBugs: SAQ #73

Case: Haemoptysis

A 69-year-old lady presents to your tertiary ED with a 1-hour history of haemoptysis. She states that she has coughed up about 2 cups of bright red blood. Past medical history includes breast cancer with a right-sided mastectomy and she is on apixaban for paroxysmal AF. 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 (5) differential diagnoses for haemoptysis 5 marks

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

3. Give (2) therapies including dose and route that can be given. 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. In addition to worsening respiratory failure, what are (2) other indications for intubation. 2 marks

6. State (4) modifications to your standard approach to RSI 4 marks

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