Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Hemoptysis

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In one line

·Blood is coming from the lower airway — the breathing tubes and lungs — not the nose, mouth, or throat.

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Normal physiology

·The lungs have two separate blood supplies doing two different jobs, and understanding both is the key to knowing why big bleeds happen.

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What goes wrong

·A blood vessel in or around the lung cracks open and pours blood into the breathing tubes, blocking air from moving and threatening the airway.

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Hallmark signs

·Coughing up blood that is bright red, frothy, and mixed with air bubbles
·Shortness of breath or feeling like you cannot get enough air
·Cough that keeps happening or gets worse
·Chest pain on one side, especially when you breathe in deeply
·Fever and chills
·Weight loss you did not try for, or feeling very tired all the time
·Fast heart rate or feeling your heart pounding
·Wheezing or a whistling sound when you breathe

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Red flags · escalate now

·Coughing up more than a few teaspoons of blood at once, or blood that keeps coming in large amounts (this can block your airway or mean a major vessel is torn)
·Sudden trouble breathing, very fast breathing, or blue lips or fingertips (signs your oxygen is dangerously low)
·Feeling dizzy, confused, or about to pass out (your brain is not getting enough oxygen or you have lost a lot of blood)
·Chest pain that is severe, crushing, or spreads to your arm or jaw (could be a heart problem or a clot in the lung artery)
·History of recent surgery, long travel, or a known clotting disorder (raises the chance of a pulmonary embolism (a clot lodging in a lung artery), a clot blocking the lung)

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Workup

·Complete blood count (CBC)
·Prothrombin time (PT), international normalized ratio (INR), and partial thromboplastin time (PTT)
·Type and crossmatch (blood bank)
·Chest X-ray
·CT scan of the chest with contrast
·Flexible bronchoscopy
·Arterial blood gas (ABG)

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Treatment

·Position bleeding lung down (lateral decubitus with bad side down), give oxygen, and prepare for intubation with a double-lumen tube if massive bleed
·Bronchial artery embolization (interventional radiology threads a catheter into the bronchial artery and blocks it with coils or particles)
·Stop anticoagulants (warfarin, heparin, DOACs) and antiplatelet drugs (aspirin, clopidogrel); reverse warfarin with vitamin K and four-factor prothrombin complex concentrate (PCC), or reverse dabigatran with idarucizumab
·Rigid bronchoscopy with tamponade (packing with gauze or a balloon), topical epinephrine (squirted onto the bleeding site to shrink vessels), or cold saline lavage (washing with icy salt water to clot blood)
·Treat the underlying cause: antibiotics (amoxicillin-clavulanate or a fluoroquinolone) for bronchiectasis or bacterial bronchitis, four-drug anti-TB therapy (rifampin, isoniazid, pyrazinamide, ethambutol) for tuberculosis, antifungals (voriconazole or amphotericin) for aspergilloma (fungal ball), chemotherapy or radiation for lung cancer, immunosuppressants (cyclophosphamide and steroids) for granulomatosis with polyangiitis or Goodpasture syndrome
·Oxygen by nasal cannula or mask, IV fluids (normal saline or lactated Ringer), type and cross for packed red blood cells, transfuse if hemoglobin drops more than 2 g/dL or the person becomes dizzy, pale, or with a racing heart (tachycardic)
·Tranexamic acid (antifibrinolytic that stops clot breakdown) 1 g IV over 10 minutes, then 1 g IV over 8 hours

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NCLEX trap

·Extra fluids make it worse because more volume can pool in the airway and drown the patient. The real danger in coughing up blood (hemoptysis) is not running out of blood — it is choking on it. Keep fluids tight and focus on keeping the airway clear.
·Sitting upright or lying on the bleeding side (good lung up) uses gravity to keep blood away from the healthy lung. If you lie the patient flat, gravity lets blood spill into both lungs and block the airway. Position the patient to protect the working lung.
·First find out what is bleeding and why. Coughing up blood (Hemoptysis) can come from tuberculosis, lung cancer, a blood clot in the lung (pulmonary a traveling clot lodging in a vessel (embolism)), inflamed blood vessels (vasculitis), or bronchitis. Not all of these need antibiotics. Treat the real upstream cause, not just the blood.
·In massive coughing up blood (hemoptysis) (coughing up a cup or more of blood in 24 hours), the patient needs an airway and oxygen now. Imaging comes after the patient is safe. The order is: stabilize the patient first, figure out the cause second, treat the cause third.
·Coughing up blood (Hemoptysis) is bright red, frothy blood coughed up from the airway — no food chunks. Vomiting blood (Hematemesis) is darker, thicker blood vomited from the stomach, often mixed with food or looking like coffee grounds. They come from different places and need different treatment.
·Stop the blood thinner right away when coughing up blood (hemoptysis) starts. Find out why the patient is bleeding. Once the bleeding is controlled and you know the cause, then decide carefully with the team if the blood thinner can restart later — weigh the clot risk against the bleed risk.

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