Refer here for part I of this case

Management

• Airway - this patient asphyxiated and lost pulses for that reason
• Suctioning is key. Refer here.
• Direct laryngoscopy is preferred over video laryngoscopy in large volume reguritation. 
• Place an 8-0 ETT to facilitate bronchoscopy. 
• Mainstem the tube if possible
• Place the patient with the bleeding lung down to avoid soiling of the normal lung.
• Should I place a double lumen ETT?
• Balloon in bronchus and balloon in trachea which helps ventilate both lungs while simultaneously preventing soiling of good lung. 
• 50% are misplaced even when in the OR by thoracic anesthesiologists and you can't perform bronchoscopy through them.
• Mechanical Ventilation: Manage the vent like ARDS (kind of) as this is a gas exchange and shunt problem. 
• There are no universal vent management strategies in massive hemoptysis. 
• Recruitment maneuvers were attempted three times.
• BVM with PEEP valve was used when patient's pulse oximetry dropped to ~ 50%
• Transitioned from PRVC to Pressure Control 
• Paralytic was used
• Epoprostenol was started
• ARDS Maneuvers for Refractory Hypoxemia that are not applicable to this patient:
• Proning - can soil good lung and difficult logistically in the Emergency Room
• APRV - not appropriate for this patient because need spontaneous breathing (this patient is paralyzed) and patients with hypercapnic respiratory failure/respiratory acidosis (as in this case) don't do well with this mode. 
• ECMO was discussed but patient did not fail primary management (Bronchoscopy v. Embolization)