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Post-tonsillectomy hemorrhage
From WikEM
Contents
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
- Coxsackievirus
- HIV (Acute Retroviral Syndrome)
Noninfectious
- Stevens-Johnson Syndrome
- Pemphigus
- Angioedema
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
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, rebleeding is common and many require surgical management
- Can try direct pressure with tonsillar pack or gauze infused with lido with epi on a long clamp
- 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.
Authors
Sharon Cu, Neil Young, Ted Fan, Ross Donaldson, Daniel Ostermayer
