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Massive haemoptysis in bronchiectasis — SCE Acute Medicine MCQ

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ModerateRespiratory medicineMassive haemoptysis in bronchiectasisSCE Acute Medicine

A 45-year-old man with bronchiectasis coughs up approximately 300 mL of bright red blood in the AMU. He is anxious, oxygen saturation is 88% on 15 L/min oxygen, blood pressure 98/62 mmHg and haemoglobin has fallen from 131 to 104 g/L. Chest radiograph shows right lower-zone cystic change but no pneumothorax. What is the most appropriate next step in management?

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Correct answer: B — Place him right side down and involve anaesthetics, respiratory and interventional radiology urgently

Massive haemoptysis threatens life through asphyxiation and requires airway protection, positioning with the bleeding side down and urgent specialist input for bronchoscopy or bronchial artery embolisation. Nebulised tranexamic acid may be used as an adjunct locally, but it is not definitive management in an unstable patient. Anticoagulation would be hazardous unless there is a compelling indication.

Reference: BTS bronchiectasis guideline; BTS clinical statement on bronchoscopy and haemoptysis