Immediate Questions

A. Is it hemoptysis? Blood from a nasal, oral, or gastric source may be aspirated to the larynx and expectorated. Look for bright red or rust color, frothiness, or a mixture with purulent sputum. May be preceded by a gurgling noise in the large airway.

B. What is volume of blood loss? May be blood-tinged to massive.

2. Moderate. Blood loss is 20-200 mL/24 h.

3. Massive. Blood loss is > 8 mL/kg/24 h, or 200-600 mL/24 h. This is a life-threatening problem that demands ICU admission and rapid diagnostic evaluation.

C. Are there associated respiratory symptoms? Chronic cough suggests infection, cystic fibrosis (CF), bronchiectasis, or foreign body. Dyspnea suggests pulmonary hypertension or idiopathic pulmonary hemorrhage (IPH). Wheezing suggests foreign body or IPH.

D. Does patient have chest pain? Chest pain can occur with acute lower respiratory infection, trauma, or pulmonary embolism.

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