“Coughing Up Blood”

Chief Complaint

  • 35 year old African-American woman presents to Emergency Department with coughing up blood

HPI

  • Has been coughing up moderate amounts of blood with clots over the past 3 hours
  • Has associated shortness of breath
  • Associated lower extremity swelling noticed over the past week
  • Denies fevers, chest pain, dizziness, lightheadedness, or any prior episodes

PMH

  • No significant past medical history

Family History

  • Father with hypertension on amlodipine
  • Mother with COPD

Social History

  • No smoking or illicit drug use
  • Social alcohol consumption
  • Lifelong midwestern United States resident
  • No history of incarceration or homelessness

Vitals

Temp: 37.4° C, BP: 98/52 mmHg, HR: 112 bpm, RR: 24 rpm, SpO2: 84% on room air

Physical Exam

  • Alert, oriented, moderate distress with frequent coughing with occasional blood-streaked sputum and blood clots
  • Diffuse, wet crackles auscultated throughout posterior lung fields
  • Increased work of breathing with use of accessory muscles
  • Heart rate tachycardic, normal in rhythm without murmurs
  • Abdomen soft, nontender, nondistended
  • 3+ pitting edema in bilateral lower extremities

What would you do next for this patient?

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