Initial Management

1. Arrange ICU admission for patients with massive hemoptysis or impending respiratory failure.

2. Protect airway; this may require early intubation. Death occurs from asphyxia rather than hemorrhage.

3. Establish IV access for fluid resuscitation and medications.

4. Correct any underlying coagulopathy.

5. Order bed rest, with partial cough suppression using narcotics.

B. Bronchoscopy. Arrange early if diagnosis is in doubt or hemoptysis continues. Bleeding may be controlled with topical therapy, bronchoscopic pressure, or endobronchial tamponade.

C. Pulmonary Medicine Consultation. Consider ENT, general surgery, or thoracic surgery consultation for massive or continuous hemoptysis. May require laser therapy, endoscopic tumor resection, or lobectomy. Pneumonectomy is rarely required in children.

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