Synopsis
Confirm true lower-respiratory bleeding, protect the airway in life-threatening haemoptysis, and identify malignancy, infection, bronchiectasis, vascular disease and treatment-related bleeding through a severity-led investigation pathway.
- First confirm the source: haemoptysis is coughed from below the larynx, while epistaxis, oral bleeding and haematemesis require different pathways.
- Severity is physiological, not purely volumetric. Airway flooding, impaired gas exchange, haemodynamic instability or continuing brisk bleeding defines an emergency even when volume is uncertain.
- Ask about lung-cancer risk, bronchiectasis, tuberculosis exposure, infection, pulmonary embolism, autoimmune disease, recent procedures and anticoagulant or antiplatelet treatment.
Key red flags
Active bleeding with inability to clear blood, falling saturation, respiratory distress, reduced consciousness, hypotension or a rapidly filling airway requires simultaneous resuscitation and haemorrhage control. Reported millilitres should not delay escalation.
Investigation priorities
Determine whether haemoptysis is immediately threatening airway, ventilation or circulation.
Management branches
Airway contamination, gas-exchange failure, haemodynamic compromise or continuing brisk haemoptysis.
- Activate major clinical support including anaesthesia, respiratory, interventional radiology and thoracic surgery; use high-flow suction, monitoring, large-bore access and blood preparation while protecting staff and patient.
- If the bleeding side is known, position that lung dependent where feasible to protect the other lung; provide oxygen and ventilation support, recognising that a large single-lumen airway may be required for suction and bronchoscopy.
Blood-streaking or small-volume haemoptysis with stable airway, oxygenation and haemodynamics.