Adult Critical Care Specialty (ACCS) Practice Exam

In a patient who has coughed up large amounts of bright red blood, what is the most appropriate procedure to recommend?

1. Transesophageal echocardiography

2. Bronchial artery embolization

3. Thoracotomy

4. Pulmonary function test

The correct answer is: Bronchial artery embolization

In the case of a patient who has coughed up large amounts of bright red blood, the recommendation for bronchial artery embolization is established as the most appropriate procedure due to several key reasons. First, coughing up bright red blood, known as hemorrhagic sputum, is indicative of a potentially serious condition involving the respiratory system, particularly from the lungs or bronchial vessels. There is a significant risk of continuous bleeding or other complications; therefore, an effective and immediate intervention is necessary. Bronchial artery embolization is specifically designed to control hemoptysis by targeting the blood supply to the bronchial arteries, which may be the source of the bleeding. The procedure involves the minimally invasive technique of navigating catheters to the bleeding vessel and selectively blocking it with materials that induce clotting. This approach not only addresses the immediate risk of significant blood loss but also allows for preservation of lung function compared to more invasive surgical options. In contrast, other procedures mentioned do not directly address the immediate concern of massive bleeding from the bronchial or pulmonary vessels. Transesophageal echocardiography, while useful for assessing cardiac conditions, does not provide immediate hemostatic intervention. Thoracotomy, being a more invasive surgical procedure, is typically