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Massive haemoptysis in bronchiectasis — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsMassive haemoptysis in bronchiectasisSCE Acute Medicine

A 59-year-old man with bronchiectasis presents with 200 mL of fresh haemoptysis over two hours. BP is 106/64 mmHg, HR 118, SpO2 91% on 4 L oxygen and he is coughing repeatedly. Chest radiograph shows right upper-lobe bronchiectatic change. What is the most appropriate immediate management priority?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Protect the airway and position him bleeding-side down while arranging urgent interventional radiology review

Massive haemoptysis threatens life through airway flooding, so airway protection and positioning the suspected bleeding lung dependent are immediate priorities while definitive bronchial artery embolisation is arranged. Oral therapy and outpatient bronchoscopy are unsafe in active major bleeding. Bronchodilators may help coexistent bronchospasm but do not control haemorrhage. The pearl is that haemoptysis mortality is often due to asphyxiation rather than blood loss.

Reference: BTS bronchiectasis guideline, BTS emergency respiratory care guidance