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Post-tonsillectomy haemorrhage occurs in 2 – 5% of patients. It may present as bleeding from the mouth or nose following a recent tonsillectomy or in young children who have recently undergone tonsillectomy who present with poor oral intake, malaise and/or any excessive swallowing or bloody sputum.
While the majority of post-tonsillectomy bleeds are self-limiting, a significant minority need return to theatre urgently for control of the haemorrhage. ENT should be notified about ALL patients admitted with post- tonsillectomy bleeding. A small, self-limiting bleed may often be a prelude to a larger bleed (a ‘heralding bleed’) within the next 24 hours and thus all patients must be admitted to observation.
Bleeding may be primary (occurring within the first 24 hours after the operation) or secondary (may occur up to 28 days post-surgery and frequently presents between five and nine days after their procedure). The cause of secondary post-tonsillectomy bleeding is not clear – there may be infection of the post-op sloughy material in the tonsillar fossa.
Use an ABC approach
- Get help early – alert ENT
- Insert a large-bore IV cannula and send bloods for FBC, clotting and G&S +/- crossmatch
- Gently suction blood from the mouth
- IV analgesia
- IV fluid resuscitation
- Ice pack on the back on the patient’s neck
- Tranexamic acid
- Hydrogen peroxide gargles (if not heavily bleeding)
- Apply topical adrenaline soaked gauze to the bleeding point