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FOCUSED SHIFT VIEW

Hemoptysis

Protect the good lung; find whether this is massive.

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Confirm true hemoptysis (not hematemesis or a nosebleed).
  2. Massive is about the airway and gas exchange, not a millilitre cutoff.
  3. Bleeding lung down; call bronchoscopy and IR.

2 · Escalate now if

  • Any volume with hypoxia, shock, or inability to protect the airway
  • Rapidly falling hemoglobin or bilateral infiltrates (DAH)
  • TB risks with hemoptysis
  • Anticoagulation with more than streaks
  • Known aspergilloma, cavity, or cancer
  • Hemoptysis plus VTE risks

3 · Immediate workup

  • Upright posture; bleeding lung dependent if the side is known
  • SpO₂, CXR, POCUS lungs; type & crossmatch if more than streaks

4 · Don’t miss

  • Massive / airway-threatening hemoptysis
    Sit up, bleeding-side down, low-volume ventilation of the good lung; reverse coagulopathy; call bronchoscopy and bronchial-artery embolization.
  • Diffuse alveolar hemorrhage
    Falling hemoglobin, dropping saturations, bilateral infiltrates — capillaritis, cocaine, anticoagulants; bronchoscopy, immunosuppression per cause.
  • Pulmonary embolism
    Hemoptysis can be the presenting feature; do not assume “bronchitis” in a patient with VTE risks.
  • Lung cancer / aspergilloma / bronchiectasis
    The most common sources of massive bleeding in adults — CT and IR, not a discharge inhaler.
  • TB / necrotizing pneumonia / lung abscess
    Fever, night sweats, endemic or reactivation risk — isolation + imaging + micro.

5 · Disposition lane

Admit

Recurrent or moderate-volume bleeding, need for further imaging, infection on IV therapy, anticoagulation management.

ICU / IR / bronchoscopy

Airway-threatening or massive hemoptysis, DAH, unstable PE, need for embolization or intubation.