sunny2
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Samantha fox a 55 year old lady comes to you with complaints of blood while coughing, she is talking to you and simultaneously coughing blood clots , samantha is very cooperative during your physical examination and even talking to you about her upcoming music album. her vitals are BP 110/90, pulse 92,temperature 99, RR-16. you decide to admit her and start IV line , now what is that you do next :
1.portable chest X-ray in prone position
2.CT scan in prone position
3.Esophagogastroduodenoscopy
4.USG
5.CT scan with contrast
6.rigid bronchoscopy
7.barium swallow
8.ECG
9.flexible brochoscopy
10.immediate sclerotherapy
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| brucella2007
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6. rigid bronchoscopy
though currently vitaly stable, if she is coughing up blood clots as in PC, id say she has massive memoptyssis. flexible duznt help in Mx ..rigid duz.
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| sunny2
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I forgot to add she is a chronic smoker and was diagnosed with chronic bronchitis and also has a history of MDR tuberculosis 
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| sunny2
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and is an alcoholic offcourse
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| brucella2007
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but id still go for rigid bronchoscopy!!
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| brucella2007
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i think those r just distractors which wud lead us to doing CXR etc ..
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| study_ing
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so 6 it is 
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| MDcooper
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what is the diagnosis?
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live and let live.
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| study_ing
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sunny 2, ur thoughts please
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| sunny2
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brucella2007 was right
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| sunny2
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Rigid bronchoscopy is indicated in patients with massive hemoptysis as it allows rapid visualization of the bleeding site and to control the bl;eeding via cauterization or other means .
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| study_ing
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MD cooper, the point is not the diagnosis but the management, which is y the usmle will throw distractors for u. the point is not wether this pt has TB or cancer. what we gotta see is that they r coughing massive blood and are likely to destabilize ( though im surprised they havent yet).
hence ur next step is a procedure which will enable dx, yes, but more importantly, deal with it urgently.
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If you yourself are at peace, then there is at least some peace in the world.
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| sunny2
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Study_ing rocks
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| docnikki
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Hemoptysis is potential indication for rigid bronchoscopy. In patients whose bleeding is massive and not controlled using the flexible bronchoscope with its small 2.0-mm suction channel, access to the airways through the rigid tube allows selective intubation and insertion of large suction tubing to remove blood clots; it also allows the operator to stop the bleeding by laser photocoagulation, tamponade techniques (with forceps, sponges, or the rigid tube itself), and insertion of larger tamponade balloons. Ventilation can be assured throughout the procedure, and access to the airway is not hindered by a small endotracheal tube. When using the rigid bronchoscope for massive hemoptysis, long ventilating tubes, usually of 12-mm diameter, should be inserted to gain greatest access to both the proximal and distal airways
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