Table 1.
ABCDE approach for massive hemoptysis
| Toolbox Category | Components | Considerations |
|---|---|---|
| Assess the airway | Aspirate | Clear the airway |
| Airway | Big 0: Large-bore endotracheal intubation | |
| 1: Mainstem bronchus intubation | ||
| 2: Double lumen intubation* | ||
| Anesthesia | ||
| Block the blood | Bad side down | Lateral decubitus positioning |
| Bronch | Lateralize the bleed | |
| Clear the airway | ||
| Direct tube | ||
| Endobronchial blocker | ||
| Cause a clot | Compression | Direct tamponade |
| Wedge | ||
| Cold | Ice-cold saline irrigation | |
| Vasoconstriction | Epinephrine | |
| Vasopressin | ||
| Coagulants | Thrombin with or without fibrin | |
| Tranexamic acid | ||
| Oxidized regenerated cellulose | ||
| Cautery | Electrocautery | |
| Argon plasma coagulation | ||
| Laser | ||
| Definitive therapy | IR consult | Bronchial artery embolization |
| Surgical consult | Resection | |
| Rigid bronchoscopy | ENT, IP, surgery | |
| Everything else | Eye on the patient | Vital signs |
| Volume resuscitation | ||
| Lab evaluation | ABG | |
| BUN | ||
| CBC | ||
| Coags | ||
| Type and crossmatch | ||
| Ensure coagulation | Medication review | |
| Correct coagulopathies |
Definition of abbreviations: ABG = arterial blood gas; BUN = blood urea nitrogen; CBC = complete blood count; Coags = coagulation testing including prothrombin time, partial thromboplastin time, and international normalized ratio; ENT = ear, nose, and throat surgery; IP = interventional pulmonology; IR = interventional radiology.
The first column contains the toolbox categories, the second column shows components to consider within each category, and the third column lists relevant data and diagnostic or therapeutic considerations for components.
*
Double-lumen intubation is not recommended for most cases of massive hemoptysis.