Chief Complaint: Hemoptysis
History of Present Illness: The patient has been brought to the emergency department by her
mother. She is a 22-year-old female with cystic fibrosis. She has had a
1-day history of hemoptysis. She has been feeling tired for
5 days. Her mother says that the patient has had mild dyspnea and
cough. The patient’s last PFTs were much worse than normal for her.
She has not had any epistaxis, bleeding from her gums, bloody stool, or
easy bruising.
Past Medical History: Cystic fibrosis; bronchiectasis.
Medications: Inhaled antibiotic (tobramycin); mucolytic agent (pulmozyme); vitamins ADEK; bronchodilator (albuterol).
Allergies: NKDA.
Social: She is a nonsmoker. She is a sophomore in college and lives with her
parents.
Surgical History: None.
Physical Exam: RR: 30; HR: 92; Temp: 102.1°F; BP: 90/57; Pulse ox: 89%
Gen: Mildly cyanotic. In mild respiratory distress.
Her nose and mouth are a little dry.
HEENT: Her ear drums and ear canals are normal.
CV: Mildly tachycardic. No murmur. Her pulses are a little weak.
Resp: Tachypneic, shallow breaths, breath sounds are weaker than normal
bilaterally.
GI: Normal. Her liver and spleen are not large.
Emergency Department Course: When she came to the ED, the patient was in acute respiratory distress. She was intubated with an endotracheal tube and placed on
SIMV. A CXR verified correct placement in her trachea. She had poor
circulation, so she was given IVF and transfused with 2 units of blood
(prbcs). An ABG showed hypoxemia and hypercapnia, both of which
improved on follow-up ABG after she was intubated. The pulmonology
team was contacted; the team decided bronchoscopy would be best.
The team found that she was bleeding in her bronchi and treated her
with endobronchial electrocautery. Afterward, she was transferred to
the ICU for further care.