Today, I am joined by my buddy and pulmonary-critical care stud, Oren Friedman, to discuss the management of Massive Hemoptysis

See More from Oren

* Clot Management of Massive and SubMassive PE

* Hemodynamic Management of PE

Some Basics on Massive Hemoptysis

* LitFL

* First10 EM

* Review by Sakkour on Massive Hemoptysis

* IBCC chapter  Severe hemoptysis

* A Wee Bit More on Massive Hemoptysis

Intubate Big

Localize

C-XR, chart review, and initial bronch. Remember Oren's tip: if you get in there and can't find any bleeding, temporarily disconnect the vent

Is it Amenable to Bronch Treatment?

If not, Block; preferably at the segmental level

Use a bronchial blocker, not a double lumen tube

Uni Blocker

EZ Blocker

A poor 2nd choice is mainstem intubation

Bougie for selective lung

Then Get a CTA of the Chest

make sure to order a delayed phase to see the systemic circulation as well

Then go to IR for Bronchial Artery Embolization

95% of the lesions will arrise from the bronchial circulation. The ones that don't are PE, Pulmonary Art Catheter mishaps, and AVMs of the Pulmonary arterial circulation.

If that fails, Surgery or ECMO

Updates

* Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. 2018 Oct 12. pii: S0012-3692(18)32572-8. doi: 10.1016/j.chest.2018.09.026.

* Great Review Article from CHEST

Now, On to the Podcast...