Identify the key steps to management of massive (> 500 cc in 24 hour period) hemoptysis in the emergency department.

1. Asphyxiation, NOT blood loss, is generally the cause of death.  Intubate with size 8.0 or larger endotracheal tube.  Larger tube will facilitate bronchoscopy. 
2. Obtain chest x-ray and place patient with bleeding site down, if identifiable, to prevent aspiration of blood into contralateral lung. If bleeding is from the left lung, consider advancing the endotracheal tube into the right main stem bronchus.
3. Reverse coagulopathy and thrombocytopenia. 
4. Consult pulmonary for bronch to identify and attempt to treat bleeding source.  
5. Consider thoracic surgery and interventional radiology consultations. 

Source

Kruse: Saunders Manual of Critical Care, 1st ed.

Ingbar, D.  "Massive hemoptysis: Initial management"  Up to Date.  2011 Jan.