Hemoptysis
Formal Definition
The expectoration of blood from the respiratory tract, ranging from blood-streaked sputum to massive life-threatening hemorrhage; massive hemoptysis is defined as >500-600 mL in 24 hours or >150 mL/hour; requires urgent airway management, positioning, and source control, with bronchoscopy or embolization for ongoing bleeding.
How It's Used on the Ward
Hemoptysis or coughing up blood — ranges from a few streaks to a patient drowning in their own blood; massive hemoptysis is one of the most dramatic and dangerous emergencies in medicine.
Example
"Lung cancer patient, started coughing up bright red blood, approximately 300mL in the last hour. Massive hemoptysis protocol: lay patient on the side with the bleeding lung DOWN (if known), suction at bedside, prepare for intubation with large-bore ETT (8.0 or larger). Calling interventional radiology for emergency bronchial artery embolization. STAT Chest X-ray. Type and cross for 6 units pRBCs."
Clinical Context
Massive hemoptysis definition varies by source: >500-600 mL/24h or >150 mL/h. Initial stabilization: position (bleeding side down if known, to protect the non-bleeding lung — physics, not tradition), airway (large-bore ETT or double-lumen tube for one-lung isolation), oxygenation. Rigid bronchoscopy: for identification and localization of bleeding source in massive hemoptysis. Bronchial artery embolization: definitive treatment for massive hemoptysis from nonbronchial sources. Common causes: lung cancer, bronchiectasis, TB, fungal ball (aspergilloma), pulmonary embolism, vasculitis. Do not give anticoagulation until bleeding is controlled. Pulmonary artery catheter (Swan-Ganz) rarely causes massive hemoptysis.