Wang Xiaoping, Department of Respiratory Medicine, Shandong Chest Hospital Introduction: Bleeding is one of the common complications in the process of tracheoscopy, which can be caused by brushing, biopsy and needle aspiration biopsy during the diagnosis process, and various microscopic treatments can also cause bleeding, such as argon knife cautery and cryotherapy, but the degree of bleeding varies. A small amount of bleeding can usually stop on its own, or a small amount of hemostatic drugs can be given under the microscope; heavy bleeding and bleeding is difficult to stop is relatively rare, and when it occurs, it is easy to cause asphyxiation, which makes it very difficult for medical personnel to rescue the patient. The Department of Respiratory Endoscopy of Shandong Chest Hospital, combined with the experience of many successful rescues of hemorrhage, has summarized the rescue norms in line with the actual clinical situation of the hospital, here to discuss with you, if you have better comments welcome to pay attention to the “respiratory endoscopy” WeChat public platform after the message! I. Definition: Bronchoscopy-related hemorrhage: Bronchoscopy-related operation causing bleeding greater than 100Ml and accompanied by a decrease in oxygen saturation. Preoperative assessment: 1. Preoperative assessment: ①History: heart disease, hypertension, pulmonary hypertension, history of blood disease, liver disease, renal insufficiency, radiotherapy, history of medication (anticoagulants, immunosuppression, etc.); ②Imaging; ③Treatment patients should undergo enhanced CT examination; ④High-risk patients should establish venous access in advance. 2. Intraoperative evaluation: ①Microscopic presentation: lesion site, characteristics (color, vessels, presence of pulsation, caution if blood flow is abundant!) ② operation from simple to complex, from surface to deep; ③ establishment of artificial airway: tracheal intubation, stent size; ④ whether timely intervention of vascular intervention department and thoracic surgery is needed for rescue. 3. Postoperative assessment: ① risk factors: intraoperative bleeding; ② close observation in case of hemorrhage, maintenance of intravenous access, ICU assistance, timing of further measures (bronchial artery embolization, surgical procedures). 3. drug and instrument preparation: 1. local medication: epinephrine, 1:20,000 (2mg, dissolved in 0.9% ice saline 20ml); norepinephrine, 1:10,000 (1mg, dissolved in 0.9% ice saline 20ml); thrombin, 50-200U/ml (200ug, dissolved in 0.9% ice saline 20ml). 2. intravenous medication: posterior pituitary hormone, 6-12U + 5% GS 10ml slowly sedated; thrombin 1-2KU, intravenous, intramuscular, subcutaneous injection can be used; phentolamine 0.17-0.4mg/min sedated. 3. auxiliary drugs: saline, balance solution, 5% glucose solution, dexamethasone injection. 4. Equipment preparation: oxygen supply and suction device; cardiac monitoring, finger oxygen saturation monitor, resuscitation cart; opener, laryngoscope, dental pad; different types of tracheal intubation (extended type), guiding wire; guidewire, balloon; artificial respirator; intravenous infusion device, pressurized infusion set, intravenous micro-pump; other: blood type cross-check list, transfusion application form, transfusion consent form and test tube, etc. Fourth, the steps of resuscitation: 1. high-risk patients to monitor blood oxygen and establish intravenous access; 2. bleeding with finger oxygen saturation decreased by more than 10% immediate resuscitation: (1) immediately the affected side of the position, bleeding is difficult to stop emergency tracheal intubation (sedation after intubation); (2) injection of pituitary 6U, intravenous 12U maintenance; (3) monitoring blood pressure, electrocardiography; (4) significantly elevated blood pressure or vascular sclerosis in combination with phentolamine; (5) sedation maintenance (imipramine + fentanyl) for intubation or irritability; (6) intracavitary local hemostatic drug infusion (thrombin, etc.); (7) balloon tamponade or blocking treatment; (8) blood preparation and transfusion; (9) timely blood and thrombus cleanup and close observation of patient’s vital signs; (10) bronchial artery embolization or lobectomy can be considered for patients who are ineffective or are still at risk of hemorrhage. V. Indications for bronchial artery embolization (BAE) for hemorrhage: ① other treatments are ineffective or cannot be performed; ② repeated hemoptysis; ③ although the hemorrhage is temporarily stopped, there is a fear of death from another hemoptysis; ④ there is a fear of recurrent hemoptysis after removal of the embolus. Indications for lobectomy for hemorrhage: ① Patients with bleeding volume of more than 200 ml per h or more than 600 ml per 24 h; ② clear bleeding site with limited lesions; ③ cardiopulmonary function and general condition can tolerate surgery.