Hemoptysis

1. Admit to: Intensive care unit

2. Diagnosis: Hemoptysis

3. Condition:

4. Vital signs: q1-6h. Orthostatic BP and pulse bid. Call physician if BP >160/90, <90/60; P >130, <50; R>25, <10; T >38.5°C; O2 sat <90%

5. Activity: Bed rest with bedside commode. Keep patient in lateral decubitus, Trendelenburg's position, bleeding side down.

6. Nursing: Quantify all sputum and expectorated blood, suction prn. O2 at 100% by mask, pulse oximeter. Discontinue narcotics and sedatives. Have double lumen endotracheal tube available for use.

8. IV Fluids: 1 L of NS wide open (>6 gauge), then transfuse PRBC, Foley to gravity.

9. Special Medications: -Transfuse 2-4 U PRBC wide open.

-Promethazine/codeine (Phenergan with codeine) 5 cc PO q4-6h prn cough.

Contraindicated in massive hemoptysis. -Consider empiric antibiotics if any suggestion that bronchitis or infection may be contributing to hemoptysis.

10. Extras: CXR PA, LAT, ECG, VQ scan, contrast CT, bronchoscopy. PPD, pulmonary and thoracic surgery consults.

11. Labs: Type and cross 2-4 U PRBC. ABG, CBC, platelets, SMA7 and 12, ESR. Anti-glomerular basement antibody, rheumatoid factor, complement, antinuclear cytoplasmic antibody. Sputum Gram stain, C&S, AFB, fungal culture, and cytology qAM for 3 days. UA, INR/PTT, von Willebrand Factor. Repeat CBC q6h.

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