The Oft Dreaded Post-Tonsillectomy Bleed with Dr. Sean Fox - PEM25

Post-tonsillectomy hemorrhage requires immediate clinical vigilance in the emergency department, particularly as more procedures shift to outpatient settings. Secondary bleeds, typically occurring five to seven days post-surgery when fibrin clots slough off, present a significant risk of life-threatening exsanguination. Effective management centers on early ENT consultation, even for minor sentinel bleeds, to prevent catastrophic outcomes. Clinicians should utilize nebulized tranexamic acid (TXA) and direct visualization—ideally via video laryngoscopy—to assess the tonsillar bed. When active bleeding occurs, mechanical pressure using curved McGill forceps wrapped in gauze soaked in hemostatic agents like TXA or epinephrine provides a critical bridge to surgical cauterization. Maintaining an upright position and securing the airway with direct laryngoscopy, while avoiding reliance on potentially obscured camera views, remains essential for patient safety during these high-stakes interventions.