Medical

Massive hemoptysis / airway flooding

Before / During / After / Pitfalls

Before

• Call ICU/pulmonary/anesthesia/IR/thoracic resources early; prepare blood and suction.
• Position bleeding side down if known and clinically feasible.
• Plan airway control with large enough tube for suction/bronchoscopy when appropriate.

During

• Suction continuously; avoid contaminating the non-bleeding lung when possible.
• Confirm tube and consider mainstem/isolation strategy only with expert/local pathway.
• Maintain oxygenation while arranging definitive bleeding control.

After

• Urgent bronchoscopy/IR/surgical pathway and ongoing hemorrhage resuscitation.
• Ventilator strategy depends on oxygenation, lung contamination, and hemodynamics.
• Secure tube and communicate suspected bleeding side.

Pitfalls

• Small ETT limiting suction/bronchoscopy.
• Supine position with bilateral contamination when avoidable.
• Delayed definitive hemorrhage-control team activation.