post-tonsillectomy bleeding

Introduction

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