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Rebuttal From Drs Pastis and StrangeRebuttal From Drs Pastis and Strange

Nicholas J. Pastis, Jr, MD, FCCP; Charlton B. Strange, MD, FCCP
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From the Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina.

CORRESPONDENCE TO: Nicholas J. Pastis Jr, MD, FCCP, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, CSB-812, 96 Jonathan Lucas St, Charleston, SC 29425; e-mail: pastisn@musc.edu


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following conflicts of interest: Dr Pastis received a consulting fee from Olympus Corporation of the Americas for teaching in an endobronchial ultrasound bronchoscopy course held in San Diego, California, in 2014. Dr Strange has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):598-599. doi:10.1378/chest.14-2841
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As I reflect on my most recent episode of life-threatening hemoptysis after transbronchial lung biopsies (TBLBs), I compare it to an episode from earlier in my career. Even in the busiest bronchoscopy suites, these events are rare, and a year or more may pass between episodes. My first episode occurred after performing biopsies on a morbidly obese patient with multiple comorbidities, and I was terrified. Ultimately and with difficulty, an airway was established, and the nonbleeding lung was isolated with the endotracheal tube. After 2 days in the ICU, she was safe to discharge home. During my most recent episode 12 years later, our bronchoscopy staff and I were like a well-oiled machine. Within minutes, not only was an airway established, but an endobronchial blocker was placed deftly into the left lower lobe bronchus, and we were calmly updating the family.

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