Hemoptysis is a common complaint the emergency physician encounters. Most cases are minor and treatable or self-limited. In many cases a cause is never determined. Massive hemoptysis is an occasional occurrence that must be assessed and managed swiftly. The initial approach is no different than that for any bleeding or respiratory or hemodynamically unstable patient. The emergency physician must stabilize, localize, and stop bleeding, and include required specialists to achieve that purpose. The management suggestions presented in this article are simplistic. The emergence of improved CT technology and new bronchoscopic and angiographic techniques has provided safe and effective alternatives to surgery for many causes of hemoptysis. Surgery, however, continues to be the treatment of choice for some. Being familiar with the broad list of causes is imperative to keeping an approach organized.