Haemoptysis — the massive and the management

The causes — confirm the cause list against local respiratory teaching; the held reviews establish that massive haemoptysis is mostly bronchial-circulation bleeding and that bronchial artery embolisation is the treatment of choice.^[2][3]

The management of the massive:

1. ABCDE, oxygen, resuscitation, crossmatch — massive haemoptysis is life-threatening airway obstruction, respiratory failure and/or hypotension; patients die from asphyxiation, not haemorrhagic shock.^[2]
2. Protection of the good lung per local airway protocol.
3. Airway with large-bore ETT and selective techniques per local protocol.
4. Bronchoscopy for localisation and therapy per local protocol.
5. Bronchial artery embolisation — the treatment of choice for acute massive haemoptysis.^[3]
6. Surgery for the refractory — nonsurgical control is superior in the acute situation.^[2]
7. Reversal of anticoagulation per local protocol.

The principle: the massive kills by asphyxiation, not by exsanguination — airway first, with early multidisciplinary activation.^[2]