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; O2 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.
O2 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.
-Initiate empiric antibiotics if bronchitis or infection is present.
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.
