Assessment of undifferentiated problems: Approach to haemoptysis
Haemoptysis is defined as the expectoration of blood from bronchi, larynx, trachea or lung parenchyma. It is important to differentiate if the patient has non-massive or massive haemoptysis, as the latter can be a surgical emergency. The cutoff value ranges from 100 to 600 mL of blood expectorated in a 24-hour period.
If the patient coughs up blood, it is also important to differentiate between haemoptysis, pseudohaemoptysis and haematemesis. The differentiating features may be elicited through the history or physical examination.
If it is from an upper gastrointestinal source, the vomitus will be of coffee ground appearance, with darker blood, and will be associated with
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This will include: decreasing the number of cigarettes they used to smoke, getting rid of all the cigarettes in their home, car or office, staying away from smoking areas and if applicable, learn from past cessation failures and try to explore why it failed.
Action: Any action taken by the patient should be praised and encouraged. You should encourage the patient to gain support from family, friends and co-workers and join cessation classes, groups and programmes. There is an integrated smoking cessation hotline that connects to Department of Health Smoking Cessation Services, Smoking counselling and cessation services by Hospital Authority, Youth Quitline and Women Quit provided by the School of Nursing at the University of Hong Kong, Tung Wah Group of Hospitals and also Pok Oi Hospital.
Maintenance: We should encourage and assist the patient in maintaining the new behaviour over the long haul, such as engaging in stress-reducing activities (e.g. yoga, sports), drinking water and taking deep breaths when they feel the need to smoke, keeping themselves busy with other activities