All right, so welcome back to the Internet Book of Critical Care podcast.

I'm here with Adam Thomas.

We're going to talk to you about severe homopstices.

Josh, I don't know about you, but not a lot of things can make my pucker factor go through

the roof.

When there's blood coming out of orifices, there shouldn't be.

Homoptosis is one of those,

because it doesn't take a lot of blood to just clot off that whole tricule tree.

This is a scary presentation, and I have to say that it continues to scare me, and I don't have

a super duper way to make that go away. So today, we're going to cover your approach to identification

and management. And just like upper GI bleed or lower GI bleed, it gives you a good approach to who needs

to go for IR or bronc or surgery.

But let's start it off, back up a level, general principles.

Who dies here and how do they die?

Probably one of the most important concepts is that patients die from hypoxemia and exfixiation, not from

ex-angulation. So the problem is not the blood loss from their body. The problem is the blood

accumulation of their lungs. And it only takes that one figure we all saw on Twitter circulating

from New England when that patient coughed up that entire cast of their right luck.

Yeah, exactly. It doesn't necessarily take a huge clot in the wrong place.

It can cause a lot of trouble.

So here are the goals of therapy are you want to keep blood out of the good lung and contain

it in the bad lung.

...