The EM Educator Series: He’s coughing or throwing up blood…

Authors: Alex Koyfman, MD (@EMHighAK) and Cassandra Mackey, MD // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome to this week’s EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. We are working on retroactively doing this for the past posts as well. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Mini-Cases:

# 1: A 34-year-old female presents with chest pain, shortness of breath, and hemoptysis. She has a history of SLE and appears pale and sick on initial impression. She is tachycardic and hypotensive.

# 2: A 69-year-old male with over 20 years of smoking presents with worsening cough and blood within his sputum. He denies other symptoms, and his VS are normal. However, he is concerned about the blood.

Considerations:

1. Hemoptysis vs oropharyngeal bleeding vs epistaxis vs hematemesis – how to differentiate?
2. What are the etiologies of hemoptysis?
3. ED management – what can the EP do / who can help us?
4. What should be present in your ED-based work-up?

Suggested Resources:

• Articles:
  • emDOCs Hemoptysis: Key principles and management
  • First 10 EM – Massive Hemoptysis
  • Hemoptysis – Taming the SRU
  • Crashing Patient – Hemoptysis
  • LITFL – Massive haemoptysis
• Podcasts:
  • EMCrit Podcast 199 – Management of Massive Hemoptysis with Oren Friedman
  • EMCrit-RACC – A Wee Bit More on Massive Hemoptysis
  • FOAMcast Episode 33 – Hemoptysis
• Book Chapters:
  • Tintinalli’s, 8th edition, Ch. 63

This post is sponsored by www.ERdocFinder.com, a supporter of FOAM and medical education, who with their sponsorship are making FOAM material more accessible to emergency physicians around the world.