[″ + ptyein, to spit]
The expectoration of blood that arises from the larynx, trachea, bronchi, or lungs. Massive hemoptysis, which occurs rarely, should be managed by a pulmonary specialist experienced in bronchoscopy. Small amounts of hemoptysis may occur in many illnesses, including acute bronchitis, pneumonia, pulmonary tuberculosis, and cancers of the lung. Management depends on the underlying disorder. A careful history and physical examination, along with chest x-ray examination and laboratory studies, often help identify the underlying cause. SEE TABLE: Comparison of Hemoptysis and Hematemesis; SEE: bleeding; SEE: hematemesis; SEE: hemorrhage.
Vital signs are monitored to determine the patient's stability; special emphasis is placed on evaluations of respiration and hemodynamics. Standard precautions are used when blood and secretions are handled and when the patient is cleansed. Expectorated blood is inspected to assist in determining the site of bleeding. Blood and secretions are saved for the physician's inspection and possible laboratory analysis. A quiet, calm, and reassuring environment is maintained. The patient is placed on bedrest with the head slightly elevated and turned to keep the bleeding side, if known, down. Oral care is provided and fluids are administered as ordered. Excessive coughing is discouraged. Anticoagulants are withheld.
Comparison of Hemoptysis and Hematemesis
|Blood is coughed up.
|Blood is vomited.
|Blood is frothy, bright red, and alkaline.
|Blood is either dark or bright red, usually not frothy, and acid. It may have a coffee-ground appearance.
|Blood may be mixed with sputum.
|Blood may be mixed with food or bile.
|Dyspnea, pleuritic pain, or other chest discomfort is common.
|Nausea or abdominal pain is common.
|Underlying diagnoses commonly include bronchitis, pneumonia, tuberculosis, nosebleed, lung cancer, pulmonary embolism or infarct, foreign bodies, and, rarely, autoimmune illnesses.
|Underlying diagnoses commonly include peptic ulcers, gastritis, esophagitis, duodenitis, esophageal varices, upper GI tumors, vascular malformations, nosebleed, and tears in the esophagus.
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