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Massive haemoptysis — ACEM Fellowship MCQ

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HardRespiratory emergenciesMassive haemoptysisACEM Fellowship

A 64-year-old with bronchiectasis is coughing large volumes of blood, becoming hypoxaemic and tiring. The bleeding side is known to be the left lung. What is the immediate management priority?

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Correct answer: E — Position the left lung down and secure a large-bore airway

The best answer is “Position the left lung down and secure a large-bore airway”. Life-threatening haemoptysis usually kills through asphyxiation rather than exsanguination. Placing the bleeding lung down protects the contralateral lung while suction, high-concentration oxygen and early large-bore intubation preserve ventilation. Anaesthesia, intensive care, respiratory and interventional radiology support should be mobilised concurrently for bronchoscopic or bronchial-artery control.

Reference: NSW Agency for Clinical Innovation: Massive haemoptysis clinical tool: https://aci.health.nsw.gov.au/networks/eci/clinical/tools/respiratory/massive-haemoptysis