Massive hemoptysis is an uncommon but life-threatening emergency. The loss of at least 600 mL of blood within a 48-hour period has been associated with a high mortality rate. Initial stabilization including airway and ventilation management, IV fluids, oxygen, and laboratory and radiographic studies should be done in the ED. Bronchoscopy and angiography are initial diagnostic manuevers that also may be therapeutic. Surgical therapy is reserved for patients with adequate pulmonary reserve and localized sources of bleeding.