Q; 52 year old male is transferred to floor with hemoptysis after intubation. To determine which side of the lung is have bleeding, the next step should be

A) Auscultation
B) CXR
C) CT chest
D) Change single lumen to double lumen endotracheal tube
E) Bronchoscope


Answer: A 

 CXR, CT chest, bronchoscope, changing ETT and bronchoscope are all valid in management of massive hemoptysis but they sometimes take time. Simple auscultation may provide good clue to bleeding coming from which lung. Usually it is a gurgling sound. This is an extremely important step as if auscultated well patient should be immediately placed with presumed bleeding lung in the dependent position, to prevent non-bleeding lung from spillage of blood from the bleeding lung.