Approach to a cough (subacute and chronic) Quiz: Ace Your Exams

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A 71-year-old woman presents to the emergency department due to increasing shortness of breath over the past eight hours. Over the past several months, she has had a persistent dry cough and unintentional weight loss of 10 lbs (4.5 kg). Initially, she demonstrates increased work of breathing but is not in respiratory distress. A chest radiograph is performed in the emergency department and shows a large perihilar mass. The patient subsequently becomes more short of breath and vomits more than one cup of bright red blood. A nasal cannula is placed, and oxygen is administered. Temperature is 36.3 ºC (97.3 ºF), pulse is 120/min, respiratory rate is 35/min, blood pressure is 100/64 mmHg, and oxygen saturation is 90% on 6 liters nasal cannula oxygen. On examination, the patient is in respiratory distress with intercostal retractions. There are bibasilar crackles and rhonchi in both lungs. An 18-gauge peripheral intravenous line is placed. Which of the following is the best next step in management?

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Consult interventional radiology

Perform endotracheal intubation

Consult interventional pulmonology

Place a central venous catheter

Transfuse packed red blood cells (PRBCs)