This handout is for massive (life-threatening) hemoptysis (acute airway emergency). Your care team identified this based on: expectoration of blood / blood-streaked sputum — quantify volume + rate (earwood afp 2015 pmid 25955625).
Other reasons your team may use this plan: hemoptysis with hypoxia / respiratory distress / hypotension — physiologic-massive trigger (charya 2021 pmid 34527355); red-flag escalation from pulm.bronchiectasis.core.v1 / pulm.tuberculosis.v1 / pulm.abpa.v1 when bleeding becomes life-threatening; recent swan-ganz/pa catheter, transbronchial biopsy, or lung procedure — iatrogenic pa rupture risk (charya 2021 pmid 34527355).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| bleeding_side_down_lateral_decubitus_positioning | Bleeding lung DOWN (when side known/suspected) | positioning | continuous | Protects the non-bleeding lung from soiling — asphyxiation, not exsanguination, is the killer (Charya 2021 PMID 34527355) |
| high_flow_oxygen_and_large_bore_suction | High-flow O2 to SpO2 ≥92%; continuous large-bore suction | inhaled | continuous | Maintain oxygenation while clearing airway blood (Charya 2021 PMID 34527355) |
| selective_intubation_lung_isolation | Large single-lumen ETT (≥8.0) to good lung, OR bronchial blocker, OR double-lumen tube | airway | once | Isolate/protect the non-bleeding lung; single-lumen + blocker is often more practical emergently than a DLT (Charya 2021 PMID 34527355) |
| massive_transfusion_protocol_pRBC_FFP_platelets | Balanced resuscitation per institutional MTP; correct fibrinogen with cryoprecipitate | IV | as needed | Support oxygen-carrying capacity + correct dilutional/consumptive coagulopathy; blood products have no single RxCUI → non_pharm (Charya 2021 PMID 34527355) |
Plan: Massive hemoptysis — airway-first resuscitation → coagulopathy reversal + TXA → BAE → bronchoscopic tamponade → surgery (last resort)
Call 911 or go to the nearest emergency room right away if you have:
Route BACK to the underlying-disease engine for definitive management once airway secured — bronchiectasis airway clearance (pulm.bronchiectasis.core.v1), TB therapy (pulm.tuberculosis.v1), ABPA/aspergilloma steroids+antifungal (pulm.abpa.v1), vasculitis maintenance immunosuppression, malignancy oncology (onc.lung-cancer.core.v1); recurrence-prevention + repeat-BAE/surgery planning (Allwood Respiration 2021 PMID 33401266)
Guideline: No single society "massive hemoptysis" guideline exists — evidence floor: Charya life-threatening hemoptysis ICU review (J Thorac Dis 2021; PMID 34527355) + Earwood hemoptysis evaluation/management (AFP 2015; PMID 25955625) + CHEST nebulized-TXA RCT (Wand 2018; PMID 30321510) + Cochrane antifibrinolytics (2016; PMID 27806184) + BAE long-term series (Kim Respirology 2006 PMID 17052307; Lee Acta Radiol 2008 PMID 18210312) + PEXIVAS/RAVE for DAH (NEJM 2020 PMID 32053298; NEJM 2010 PMID 20647199); all confirmed current 2026-05-16