post-tonsillectomy bleeding

see also:

• ears, nose and throat surgery (ENT)
• tonsillectomy
• RVEEH clinical practice guideline:
  • Post Tonsillectomy Bleeding (pdf)

• bleeding after tonsillectomy can be life threatening and most patients should be admitted to hospital for at least 24hrs of observation (some with resolved secondary bleeds and no red flags may be managed at home closely observed)
• bleeding in the 1st 24hrs is a primary bleed - often require return to theatre
• bleeding after 1st 24hrs is a secondary bleed and these usually occur days 5-9 and may be associated with infection
  • a sloughy, white appearance is normal after tonsillectomy

• if heavy bleeding, airway compromise may also be an issue - consider a Code Blue to have senior anaesthetic assistance
• large bore IV access
• take bloods for FBE, U&E, CRP, Gp and hold, consider coagulation profile
• IV fluids as needed
• analgesics
• anti-emetics prn
• avoid aspirin, NSAIDs
• oxygen as tolerated if active bleeding
• nil orally
• contact ENT ASAP for advice
  • they may try local measures including:
    • peroxide gargles
    • stopping the bleeding point at the bedside or in theatre
  • consider IV tranexamic acid (Cyclokapron)
  • consider IV antibiotics if clear infective cause eg. fever, significantly raised CRP