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Massive haemoptysis — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsMassive haemoptysisSCE Acute Medicine

A 63-year-old man is assessed on the acute medical unit. He coughs approximately 400 mL of fresh blood, is tachypnoeic and desaturating. He has bronchiectasis and a left-sided coarse crackle focus. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most important immediate action?

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Correct answer: B — Give high-flow oxygen and prepare for airway support

Give high-flow oxygen and prepare for airway support is the best answer because the immediate threat in massive haemoptysis is airway obstruction and asphyxiation rather than blood loss. Give intravenous calcium gluconate with cardiac monitoring is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Positioning bleeding side down can help protect the contralateral lung while definitive help arrives.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/#acute-medicine-order-54-1