1.General treatment For patients with hemoptysis, they should rest in bed, keep quiet, avoid excessive tension, and be appropriately sedated if necessary. Coughing has an effect on hemostasis, so appropriate cough suppressant treatment should be given. If it can be determined which side the hemorrhage is on, then the patient should lie down to the affected side. For hemoptysis with a clear cause, treatment should be directed at the cause. For example, diffuse alveolar hemorrhage due to pulmonary vasculitis should be treated with plasma exchange and adrenocorticosteroid shock therapy. If the hemorrhage is so severe that respiratory failure is evident, emergency tracheal intubation should be performed. The patient’s life can be saved by suctioning out the blood through the tracheal intubation. The establishment of an artificial airway facilitates a bendable bronchoscopy. If the site of bleeding is judged, a double-lumen tracheal tube may be inserted as appropriate, isolating the bleeding side from the healthy side of the main bronchus to ensure at least one lung function. If the patient’s respiratory failure is still not relieved after clearing the airway, mechanical ventilation should be performed in a timely manner.3. Drug treatment Intravenous drip of posterior pituitary hormone or vasopressin can cause arterial constriction, thus achieving hemostasis. However, it can cause systemic vasoconstriction and uterine contraction, so it should be used with caution in the presence of coronary heart disease or hypertension, and is prohibited in pregnancy. In China, we mainly use posterior pituitary hormone, which is a water-soluble component of the posterior pituitary gland and contains oxytocin and pressor hormone, and is a common emergency drug for hemoptysis. Note that the use of such drugs may reduce bleeding, thus making it impossible to clearly show the site of bleeding when performing bronchial arteriography, causing difficulties for subsequent diagnosis and treatment. Phentolamine is an a-adrenergic blocking drug, and its hemostatic mechanism is presumed to reduce bleeding by direct vasodilation, resulting in lower pulmonary vascular resistance and lower pulmonary arteriovenous pressure. Because it is a vasodilator, it is more suitable for patients with hypertension and coronary artery disease. Other vasodilators, such as phenylephrine nitrate, may also have some effect. Procaine also has some vasodilating effect and can be used when other treatments are not effective. The dosage should not be too large and the speed should not be too fast, otherwise it may cause facial flushing, delirium, excitement and convulsions, and for those who have convulsions, isopentobarbital or sodium dumbarbital can be used to rescue them. Skin test must be performed before use, and it is prohibited for those who have a history of allergy to this drug. If the hemoptysis caused by infiltrative tuberculosis and pneumonia is not effective by the above treatment, glucocorticoids can be considered to inhibit the inflammatory response, stabilize the cell membrane and reduce the level of heparin in the body. The dosage should be reduced after the effect is seen, and the duration of use should not exceed 2 weeks. Other coagulation-promoting drugs such as tranexamic acid, carbachol, phenolsulfonamide, 5-aminohexanoic acid, bactrim, vitamin K, and Yunnan Baiyao can be tried. For hemoptysis caused by heparin anticoagulation therapy or in the presence of coagulation dysfunction or hepatic insufficiency, fisetin can be used.4. Bronchoscopic treatment To control bleeding, local hemostatic drugs can be given during bronchoscopy. Usually epinephrine is used, and prothrombin solution can also be tried. However, the exact efficacy of these treatments for hemoptysis is uncertain, and there is a lack of reliable evidence-based medical evidence. In patients with hemoptysis, the bronchus that is bleeding can be obstructed by placing a balloon catheter into the bronchus and inflating it to prevent blood aspiration into other airways, to ensure its patency, to maintain ventilation and gas exchange, and to prevent respiratory failure or even asphyxia. The diameter of the balloon can be chosen flexibly according to the size of the bronchus. Recently, some people have designed a double-lumen hemostatic balloon, which can be placed through the bronchoscopic biopsy lumen and can be injected with hemostatic drugs at the same time. After placement, the bronchoscope can be withdrawn to facilitate balloon retention and subsequent access to the endoscope to observe the bleeding. Balloon obstruction therapy is only a temporary treatment and prolonged compression may cause necrosis of the bronchial mucosa, so it is usually left in place for no more than 24 h. Direct treatment of the bleeding lesion can also be achieved by electroablation, freezing, and laser techniques under the bronchoscope to stop the bleeding. In cases where the bleeding site is located distal to the bronchus and the exact site of bleeding cannot be seen by bronchoscopy, electroablation or laser treatment should not be used, which may cause perforation of the bronchus. In this case, direct obstruction of the bleeding bronchus with a mirror or balloon can be used to achieve hemostasis.5. Bronchial artery embolization treatment With the gradual maturation of technology, the application of bronchial artery embolization to treat bronchial haemorrhage is becoming more and more common. The bleeding vessel is first identified by selective bronchial arteriography. Certain features are often indicative of the site of bleeding, such as spillage of contrast from the vessel wall or the presence of a thickened or aneurysm-like dilated twisted vessel. Embolization is performed by local injection of particles such as polyvinyl alcohol foam, isobutyl-2 cyanoacrylate, Giant-urco steel coils, or absorbable gelatin sponges into the supply vessel at the site of hemorrhage. The success rate of this treatment in controlling hemoptysis is 64% to 100%. However, recurrence occurs in 16% to 46% of patients, but there is usually no recurrence of hemoptysis. Bronchial artery embolization has a failure rate of up to 13%, mainly due to bleeding from the anastomotic branches of the phrenic, intercostal, internal mammary, or subclavian arteries. Complications of bronchopulmonary artery embolization include mainly vascular perforation, endothelial tears, chest pain, fever, embolization of other parts of the body and neurological complications, in addition to embolization itself, which can cause hemoptysis. If the anterior spinal artery is found to emanate from the bronchial artery, embolization cannot be performed because it may lead to paraplegia due to spinal cord infarction. The use of coaxial microcatheters can reduce this complication.6. Surgical treatment Surgical treatment can be considered for bleeding caused by local lesions. For lung cancer with insufficient respiratory function reserve or unresectable, it is not suitable for surgical treatment. Surgical resection is generally considered only when arterial embolization therapy cannot be performed or may be ineffective, but life-threatening hemoptysis caused by ruptured aortic aneurysm, arteriovenous malformation, encapsulation, medically induced pulmonary artery rupture, chest trauma, bronchopulmonary adenocarcinoma, and other treatment-ineffective foot mycobacteriosis is still mainly treated surgically.7.Other treatment For those whose hemoptysis cannot be controlled after various treatments and for whom surgery is contraindicated or If this is not possible, lung atrophy therapy can be considered. If the site of hemorrhage is clear, artificial pneumothorax can be used, and if the site of hemorrhage is unknown or the hemorrhage comes from the lower lung, artificial pneumoperitoneum therapy can be used. Diaphragmatic and pleural adhesions and severe cardiopulmonary insufficiency are not suitable for atrophic therapy.