Pediatric emergency medicine trisk 2794 2794

Clinical Indications for Discharge or Admission
Indications for hospitalization will vary according to the acute conditions
diagnosed and underlying severity of disease. Consultation with a pulmonologist
or the patient’s CF team may provide insight into the need for hospitalization.
Follow-Up Care
The majority of CF patients in the United States are followed in CFF approved
and supported centers. All centers’ contact information is available at the CFF
website ( ).
Close contact between emergency physicians and the CF center team caring for
this patient population facilitates acute management and continuity of care.

PULMONARY HEMORRHAGE
CLINICAL PEARLS AND PITFALLS
Pulmonary hemorrhage may be seen in acute respiratory illnesses or
after thoracic trauma, the initial presentation of a chronic vasculitic
condition, or during exacerbation of a chronic condition such as CF.
Pulmonary hemorrhage can present with significant respiratory distress
and hemodynamic compromise.
Management primarily involves assessment and support of
oxygenation, ventilation, and hemodynamics, with consideration of
diagnostic testing for the underlying condition.
Bronchoscopy is generally reserved for patients with persistent
bleeding or when diagnostically necessary.
Blood products including packed red blood cells, platelets, coagulation
factors, and fresh-frozen plasma should be considered if signs of
significant bleeding and/or shock are present.

Current Evidence
Pulmonary hemorrhage, or bleeding into the lung, most commonly manifests
clinically with hemoptysis. Although relatively uncommon, pulmonary
hemorrhage can be dramatic and life threatening. Therefore, early evaluation and

treatment is paramount.
The potential causes vary and include acute infection, exacerbation of chronic
pulmonary disease, vascular malformations, and thoracic trauma among others.
The relative frequency of causative etiologies will vary significantly by the