A 64 y/o female, nonsmoker with a hx of HTN presents your ER reporting two days of “coughing up blood”. She describes the sputum as blood streaked and intermittently with clots. She has several tissues with a small amount of blood. She denies fevers, shortness of breath, chest pain, nausea/vomiting and weight loss. A CXR is performed and shows no masses, consolidations or signs of cardiopulmonary disease. She has a negative D-Dimer test.  What is your next step in management? (scroll down for the answer)

a) Reassurance then discharge to home with primary follow up

b) Antibiotics for bronchitis and discharge to home

c) Order CT chest for further evaluation

d) Pulmonology consultation for bronchoscopy

e) Observation stay to monitor for progression to massive hemoptysis

The correct answer is a) reassurance then discharge to home with primary follow up.

Most cases of hemoptysis are mild and self limited. No further work up is required in our patient. A pulmonologist should be involved if there were concern for lung cancer or lung disease, however our patient is a non smoker and has only had symptoms for the last two days. Her short duration of cough and lack of risk factors for bronchitis make it an unlikely diagnosis and antibiotics are unnecessary.

For those rare massive hemoptysis patients, refer the Dr. Smith’s recent post from conference this week!

http://emdaily.cooperhealth.org/content/emconf-gross-hemoptysis