Recurrent large volume bleeding triggers IR activation
Disposition
ICU and high acuity criteria
ICU criteria
Intubation requirement
Ongoing active bleeding
High flow oxygen or noninvasive ventilation requirement
Hemodynamic instability
Inpatient admission criteria
Admission criteria
Moderate bleeding with unclear source
Significant comorbidity
COPD with hypoxemia
Heart failure
High risk imaging findings
Mass lesion
Cavitary disease
Observation pathway criteria
Observation suitable
Small volume bleeding with stable vitals
Completed CT and initial labs without high risk features
Discharge criteria
Discharge criteria
Minimal blood streaking only
Normal oxygenation on room air
No recurrent bleeding in ED
Benign cause identified and treated
Reliable follow up within 24 to 72 hours
Discharge Instructions
Copy discharge instructions
Summary
Seen for coughing up blood
Your vital signs and oxygen levels were stable today
Medications
Take prescribed medications exactly as directed
Avoid NSAIDs unless instructed
Activity
Avoid heavy exertion for 24 to 48 hours
Avoid smoking and inhaled irritants
Follow up
Primary care or pulmonology within 24 to 72 hours
Earlier follow up if imaging abnormality was found
Return to emergency
Any large amount of blood
Trouble breathing
Chest pain
Fainting
Fever with worsening symptoms
Recurrent bleeding after discharge
References
Guidelines and key reviews
CIRSE Standards of Practice on Bronchial Artery Embolisation for Haemoptysis 2022
Best practice procedural guidance for BAE
Complications and safety considerations
Society of Chest Imaging and Interventions consensus recommendations for management of hemoptysis 2023
Imaging and IR centered algorithms
Recurrence and follow up considerations
AAFP Hemoptysis evaluation and management 2022
Primary care and ED evaluation framework
Role of CT angiography and embolization
CHEST Managing Massive Hemoptysis 2020
Stepwise approach to life threatening hemoptysis
Airway and definitive therapy priorities
ATS Scholar ABCDE Approach for Massive Hemoptysis 2022
Cognitive aid for acute management
Emphasis on asphyxiation risk
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