Episode 24: Approach to Post-Tonsillectomy Complications

Post-tonsillectomy complications require rapid identification and systematic management in the emergency department, particularly regarding hemorrhage and dehydration. While pain, nausea, and decreased oral intake are the most frequent issues, post-operative bleeding affects up to 10% of patients and can be life-threatening. Primary bleeding occurs within 24 hours due to surgical technique or coagulopathy, while secondary bleeding typically peaks between days five and ten as the fibrin clot sloughs off. A visible "blackberry" clot in the oropharynx indicates a high risk of rupture and necessitates emergent ENT consultation. Management strategies include using cold water rinses, topical tranexamic acid (TXA), and direct pressure with epinephrine-soaked gauze. Severe cases may require ketamine for sedation, IV fluids, or blood products, with all patients exhibiting significant bleeding or visible clots requiring surgical intervention in the operating room.