Massive haemoptysis

Diagnosis: The massive haemoptysis — the large volume (the 300 millilitres in an hour), the bright red blood, the history of the bronchiectasis, and the respiratory distress and the hypoxia. This is the emergency that kills by the asphyxiation.^[1]

The immediate management — the airway and the good lung first:

1. The ABCDE, the high-flow oxygen, the two large-bore cannulae, the resuscitation, the blood group and the crossmatch.
2. The PROTECTION of the good lung — the lateral positioning with the bleeding side down (the gravity keeps the blood in the bleeding lung and away from the good lung).
3. The airway — the large-bore endotracheal tube, the selective intubation of the good lung (the double-lumen or the bronchial-blocker, or the standard large-bore advanced into the good main bronchus).
4. The bronchoscopy — the localisation of the bleed and the therapeutic (the iced saline, the topical adrenaline, the balloon-tamponade).
5. The bronchial artery embolisation — the first-line definitive, the urgent interventional radiology.
6. The surgery (the lobectomy) for the refractory.
7. The reversal of the anticoagulation if applicable (the vitamin K, the prothrombin complex); the tranexamic acid as an antifibrinolytic adjunct, not a reversal agent.

The disposition: The intensive care, the urgent bronchoscopy and the embolisation, the monitoring for the recurrence and the asphyxiation.^[1]