drdg
Forum Senior
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a 32-year-old immigrant from mexico presents following an episode of massive hemoptysis. he describes bringing up large amounts of bright red, foamy sputum. He denies any recent trauma. the patient is agigated and has difficultly speaking. BP: 100/60, Heart rate:110/min. Breath sounds are audible bilaterly. IV crystalloid is started. Portable chest x-ray shows an opacity in the right upper lobe, which of the following is the best next step in the management of this patient?
A. Chest CT
B. Upper GI endoscopy
C. Bronchscopy
D. Pulmonary Arteriography with embolization
D. Immediately thoracotomy
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| dr confused
Forum Senior
Topics: 66
Posts: 107
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bronchoscopy
what is the answer plz?
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| spmvj
Forum Newbie
Topics: 3
Posts: 36
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C.
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| Ivonne
Forum Guru
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| drdg
Forum Senior
Topics: 31
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Yes, the correct answer is C.
This man may have TB complicated with hemoptysis. Emergency rigid bronchoscopy is both diagnostic ( bleeding source) and treatment.
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| hanialkhadher
Forum Elite
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can you explain more, according to Harrison guidelines the next step should be CT 
Also take a look at this link from American Family Physician journal ,
http://findarticles.com/p/articles/mi_m3225/is_7_...
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| doyoudig
Forum Guru
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I also thought CT should be next then lesion then bronchoscopy
can somone explain pls??
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| DrVirgo
Forum Hero
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Rigid Bronchoscopy is indicated in massive hemoptysis because it allows visualization and intervention by cauterization.
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| kpmle2
Forum Elite
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Agree with Dr Virgo. This patient is agigated and has difficultly speaking.. So answer is C.
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| doyoudig
Forum Guru
Topics: 144
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thx guys I knew I must have missed something here
What though if there was no Hemoptysis and Pt had the above findings on CXR
would CT be the next approriate Step??
thx much
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| hanialkhadher
Forum Elite
Topics: 16
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I got it,This patient will need Airway as first priority, and may benifit from ballon inflation to tamponade the bleeding lung and protect the non bleeding lung from aspiration, all of which are done by rigid bronchoscopy.
The Bottom line is put ABC as first priority as applicable,
Make sure you have a very good sleep before exams and emergency shifts
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| elitoki
Forum Guru
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Posts: 508
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Massive hemoptisis ---> do Rigid Bronchoscopy
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