26 Hemoptysis
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Hemoptysis
1. Admit to: Intensive care unit
2. Diagnosis: Hemoptysis
3. Condition:
4. Vital signs: q1-6h. Orthostatic BP and pulse bid. Call physician if BP
>160/90, <90/60; P >130, <50; R>25, <10; T >38.5
C; O
2
sat <90%
5. Activity: Bed rest with bedside commode. Keep patient in lateral decubitus,
Trendelenburg's position, bleeding side down.
6. Nursing: Quantify all sputum and expectorated blood, suction prn. O
2
at
100% by mask, pulse oximeter. Discontinue narcotics and sedatives. Have
double lumen endotracheal tube available for use.
7. Diet:
8. IV Fluids: 1 L of NS wide open (
6 gauge), then transfuse PRBC, Foley to
gravity.
9. Special Medications:
-Transfuse 2-4 U PRBC wide open.
-Promethazine/codeine (Phenergan with codeine) 5 cc PO q4-6h prn cough.
Contraindicated in massive hemoptysis.
-Consider empiric antibiotics if any suggestion that bronchitis or infection may
be contributing to hemoptysis.
10. Extras: CXR PA, LAT, ECG, VQ scan, contrast CT, bronchoscopy. PPD,
pulmonary and thoracic surgery consults.
11. Labs: Type and cross 2-4 U PRBC. ABG, CBC, platelets, SMA7 and 12,
ESR. Anti-glomerular basement antibody, rheumatoid factor, complement, anti-
nuclear cytoplasmic antibody. Sputum Gram stain, C&S, AFB, fungal culture,
and cytology qAM for 3 days. UA, INR/PTT, von Willebrand Factor. Repeat CBC
q6h.
Anaphylaxis
1. Admit to:
2. Diagnosis: Anaphylaxis
3. Condition:
4. Vital signs: q1h; Call physician if BP systolic >160, <90; diastolic. >90, <60;
P >120, <50; R>25, <10; T >38.5
C
5. Activity: Bedrest
6. Nursing: O
2
at 6 L/min by NC or mask. Keep patient in Trendelenburg's
position, No. 4 or 5 endotracheal tube at bedside.
7. Diet: NPO
8. IV Fluids: 2 IV lines. Normal saline or LR 1 L over 1-2h, then D5 1 NS at 125
cc/h. Foley to closed drainage.
9. Special Medications:
Gastrointestinal Decontamination:
-Gastric lavage if indicated for recent oral ingestion.
-Activated charcoal 50-100 gm, followed by cathartic.
