Postoperative Tonsillectomy and Adenoidectomy (T&A) Bleed Clinical Pathway – Emergency Department, Inpatient and PICU – History and Physical

Postoperative Tonsillectomy and Adenoidectomy (T&A) Bleed Clinical Pathway – Emergency Department, Inpatient and PICU

History and Physical

Secondary hemorrhage occurs most commonly 5–10 days following surgery

  • Risk factors include:
    • Age > 6 yrs
    • BMI > 95th percentile
    • Procedure performed for obstructive sleep apnea
  • Postoperative hemorrhage usually stops spontaneously, however:
    • Majority require 12–24 hrs of observation
    • 1–6% require OR for re-cauterization
  • Blood transfusion is rarely necessary
  • Active bleeding complicates airway management
  • Estimating blood loss is challenging as large amounts may be swallowed
General
  • Date of T&A surgery
  • Assess bleeding
    • Volume (teaspoon, ounce, cup)
    • Duration (< 1 min)
    • Number of episodes
    • Time of last episode
    • Bloody emesis
    • Nasal bleeding
  • Time of last oral intake
  • Fever, increased pain
Medications, Allergy
  • Current medication
  • Recent ibuprofen, aspirin
  • Last dose of ibuprofen, acetaminophen, celecoxib
  • Dexamethasone use
PMH
  • Difficult/critical airway
  • Coagulopathy
Physical Exam
  • General appearance
  • Mental status, pallor, vital signs
  • Evaluate for:
    • Active nasal or oral bleeding
    • Fresh clot on surgical site
    • Signs of airway obstruction
  • Difficult/Critical Airway Pathway