What is the recommended HPI template for hemoptysis?

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Hemoptysis History and Physical Examination Template

A comprehensive, structured HPI template for hemoptysis is essential for accurate diagnosis and management of this potentially life-threatening condition. 1

Chief Complaint

  • Hemoptysis (expectoration of blood from the lungs or lower respiratory tract)

History of Present Illness

Bleeding Characteristics

  • Quantity of blood expectorated
    • Estimate volume in mL over 24 hours (>100 mL may indicate massive hemoptysis) 1
    • Rate of bleeding (rapid rate correlates with higher mortality) 1
  • Duration and pattern
    • Acute vs. chronic
    • Single episode vs. recurrent
    • Intermittent vs. continuous
  • Color and consistency of expectorated blood
    • Bright red vs. dark/old blood
    • Mixed with sputum vs. pure blood
    • Presence of clots

Associated Symptoms

  • Respiratory symptoms (dyspnea, cough, wheezing, chest pain)
  • Constitutional symptoms (fever, night sweats, weight loss)
  • Symptoms suggesting specific etiologies:
    • Purulent sputum (infection)
    • Pleuritic chest pain (pulmonary embolism, pneumonia)
    • Orthopnea/PND (heart failure)

Risk Factors and Exposures

  • Smoking history (pack-years, current/former)
  • Occupational exposures (asbestos, silica, coal)
  • Travel history (TB endemic areas)
  • Tuberculosis exposure
  • Recent respiratory infections
  • Immunocompromised status

Past Medical History

  • Pulmonary conditions
    • COPD/emphysema
    • Bronchiectasis
    • Prior tuberculosis
    • Lung cancer or metastases
    • Interstitial lung disease
    • Pulmonary arteriovenous malformations
  • Cardiovascular conditions
    • Congestive heart failure
    • Pulmonary hypertension
    • Pulmonary embolism
  • Autoimmune disorders
    • Vasculitis (Granulomatosis with polyangiitis)
    • Goodpasture syndrome
    • Systemic lupus erythematosus
  • Coagulation disorders
    • Thrombocytopenia
    • Coagulopathies
    • Anticoagulant use

Medication History

  • Anticoagulants/antiplatelets
    • Warfarin, DOACs, aspirin, clopidogrel
  • NSAIDs
  • Antiplatelet agents
  • Recent medication changes

Physical Examination

Vital Signs

  • Blood pressure (hypotension may indicate massive hemoptysis) 1
  • Heart rate
  • Respiratory rate
  • Oxygen saturation
  • Temperature

General Appearance

  • Respiratory distress
  • Pallor
  • Diaphoresis
  • Cyanosis

HEENT

  • Nasal examination (rule out epistaxis)
  • Oropharyngeal examination (rule out upper airway source)

Respiratory Examination

  • Tracheal position
  • Chest wall deformities
  • Percussion (dullness suggesting consolidation/effusion)
  • Auscultation (crackles, wheezes, rhonchi, bronchial breath sounds)
  • Localized findings that may indicate source of bleeding

Cardiovascular Examination

  • Jugular venous distention
  • Heart sounds (murmurs, gallops)
  • Peripheral edema

Other Systems

  • Digital clubbing
  • Skin lesions (petechiae, purpura, telangiectasias)
  • Joint abnormalities (arthritis suggesting autoimmune disease)

Severity Assessment

  • Massive hemoptysis indicators 1, 2

    • 100 mL in 24 hours

    • Respiratory compromise
    • Hemodynamic instability
    • Need for blood transfusion
    • Two or more opacified lung quadrants on chest radiograph 1

Differential Diagnosis Considerations

  • Common causes 1, 2
    • Acute respiratory tract infections
    • Bronchiectasis
    • Lung cancer
    • COPD
    • Tuberculosis (especially in endemic areas)
    • Cryptogenic (no identifiable cause in 20-50% of cases) 2

Initial Diagnostic Plan

  • Initial imaging 1
    • Chest radiography (frontal and lateral)
    • CT chest with IV contrast if stable
  • Laboratory studies
    • CBC with platelet count
    • Coagulation studies
    • Renal function
  • Additional testing as indicated
    • Bronchoscopy
    • CT angiography for suspected vascular source

Initial Management Plan

  • Airway protection measures if massive hemoptysis 1
  • Positioning (bleeding side down if known) 3
  • Hemodynamic stabilization
  • Treatment of underlying cause

Documentation of Patient Education

  • Warning signs requiring immediate medical attention
  • Follow-up instructions
  • Medication instructions

Follow-up Plan

  • Timing of follow-up based on severity and suspected etiology
  • Monitoring for recurrence

This structured HPI template ensures comprehensive evaluation of patients with hemoptysis, facilitating accurate diagnosis and appropriate management while prioritizing patient safety in this potentially life-threatening condition.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Hemoptysis: Evaluation and Management.

American family physician, 2022

3
Research

The Diagnosis and Treatment of Hemoptysis.

Deutsches Arzteblatt international, 2017

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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