Massive hemoptysis

Q: What is the correct sequence in the management of the massive hemoptysis?

A) Establish a patent airway, insure adequate gas exchange and hemodynamics, position the patient, and control the bleeding 
B) Position the patient, establish a patent airway, insure adequate gas exchange and hemodynamics, and control the bleeding 
C) Control the bleeding, position the patient, establish a patent airway, and insure adequate gas exchange and hemodynamics
D) Insure adequate gas exchange and hemodynamics, position the patient, establish a patent airway, and control the bleeding 
E) Establish a patent airway, position the patient, insure adequate gas exchange and hemodynamics, and control the bleeding 



Answer: B 

Massive hemoptysis is a life-threatening emergency in ICU. 

As a first step patient should be positioned first with side of the bleeding lung on the dependent position to avoid spillage of blood in non-affected lung, while preparation to intubate and protect the airway, insuring ventilation and stable hemodynamics. Ultimately control of bleeding via bronchoscopy and other methods is the definite treatment.


#pulmonary
#hemodynamic



Reference:

Jean-Baptiste E. Clinical assessment and management of massive hemoptysis. Crit Care Med 2000; 28:1642.