Post-tonsillectomy hemorrhage: Difference between revisions
Neil.m.young (talk | contribs) No edit summary |
Spenceemmett (talk | contribs) |
||
| Line 23: | Line 23: | ||
*Airway management as needed (anticipate difficulty and have surgical back up) | *Airway management as needed (anticipate difficulty and have surgical back up) | ||
*IV, O2, Monitor, NPO, upright position | *IV, O2, Monitor, NPO, upright position | ||
*ENT consult: Always, | *ENT consult: Always, re-bleeding is common and may require surgical management | ||
*Can try direct pressure with tonsillar pack or gauze infused with lido with | ** Important things to discuss with ENT: patient age, level of cooperation, visible clot, hematemesis | ||
*If stable, no active bleeding, and clot is present- do not remove the clot<ref name="Otolaryngologic Procedures">Riviello R. Otolaryngologic Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.</ref> | *For minor bleeding try benzocaine spray or rinse with cold water, TXA, or lidocaine with epinephrine | ||
*Can also try direct pressure with tonsillar pack or gauze infused with TXA or lido with epinephrine on a long clamp or Magill forceps | |||
*In desperate situations may need to intubate patient and tightly pack oropharynx to tamponade bleeding | |||
*If stable, no active bleeding, and clot is present - do not remove the clot<ref name="Otolaryngologic Procedures">Riviello R. Otolaryngologic Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.</ref> | |||
==See Also== | ==See Also== | ||
Revision as of 13:47, 12 February 2019
Background
- Occurs after tonsillectomies in 3.9% of adults and 1.6% of children[1]
- Most common on POD 5-7
- Highest incidence in 21-30 year olds
- Lowest in <6 year olds
Clinical Features
- Hemoptysis
- Recent tonsillectomy
- Primary post-tonsillectomy hemorrhage from 0-24 hrs
- Secondary post-tonsillectomy hemorrhage from >24 hrs
Differential Diagnosis
- Post-op pain
Acute Sore Throat
Bacterial infections
- Streptococcal pharyngitis (Strep Throat)
- Neisseria gonorrhoeae
- Diphtheria (C. diptheriae)
- Bacterial Tracheitis
Viral infections
- Infectious mononucleosis (EBV)
- Patients with peritonsillar abscess have a 20% incidence of mononucleosis [2]
- Laryngitis
- Acute Bronchitis
- Rhinovirus
- Coronavirus
- Adenovirus
- Herpesvirus
- Influenza virus
- Coxsackie virus
- HIV (Acute Retroviral Syndrome)
Noninfectious
Other
- Deep neck space infection
- Peritonsillar Abscess (PTA)
- Epiglottitis
- Kawasaki disease
- Penetrating injury
- Caustic ingestion
- Lemierre's syndrome
- Peritonsillar cellulitis
- Lymphoma
- Internal carotid artery aneurysm
- Oral Thrush
- Parotitis
- Post-tonsillectomy hemorrhage
- Vincent's angina
- Acute necrotizing ulcerative gingivitis
Evaluation
- Physical exam (do NOT remove any clots)
- H/H
- Type and screen if not already on file
Management
- Airway management as needed (anticipate difficulty and have surgical back up)
- IV, O2, Monitor, NPO, upright position
- ENT consult: Always, re-bleeding is common and may require surgical management
- Important things to discuss with ENT: patient age, level of cooperation, visible clot, hematemesis
- For minor bleeding try benzocaine spray or rinse with cold water, TXA, or lidocaine with epinephrine
- Can also try direct pressure with tonsillar pack or gauze infused with TXA or lido with epinephrine on a long clamp or Magill forceps
- In desperate situations may need to intubate patient and tightly pack oropharynx to tamponade bleeding
- If stable, no active bleeding, and clot is present - do not remove the clot[3]
See Also
References
- ↑ Windfuhr JP and Yue-Shih C. Incidence of post-tonsillectomy hemorrhage in children and adults: A study of 4,848 patients. Ear, Nose & Throat Journal. 2002; 81(9):626-628.
- ↑ Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
- ↑ Riviello R. Otolaryngologic Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.