Coughing up blood: Massive hemoptysis

Abstract This chapter reviews the presentation and management of hemoptysis in the emergency department. The most common causes of hemoptysis are infection, malignancy, and trauma. Airway hemorrhage can cause significant hypoxic respiratory failure, and this will require modification of typical routine airway management. Care for the patient presenting with hemoptysis first involves stratifying the bleeding as mild, moderate, or massive. Initial management is to assess for airway patency, adequacy of gas exchange, and work of breathing. The mainstays of treatment of a patient with severe airway hemorrhage are early intubation, correction of coagulopathy, administration of positive end-expiratory pressure on mechanical ventilation, positioning with the affected side down, and early consultation for computed tomographic angiography and bronchoscopic-guided therapies.