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How do you manage primary haemorrhage after tonsillectomy?

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tonsillectomy AND hemorrhage

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tonsillectomy primary haemorrhage management guideline return theatre airway resuscitation

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https://entsho.com/post-tonsillectomy-bleed

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Primary haemorrhage occurs during tonsillectomy or immediately after surgery. Treat it as an airway and resuscitation emergency.
  1. Call for help immediately
    • Senior ENT surgeon, anaesthetist, theatre team, and blood bank if bleeding is significant.
    • Transfer or return to theatre without delay for persistent or brisk bleeding.
  2. Airway and positioning
    • Sit the patient upright and leaning forward, or lateral with head down if drowsy, so blood drains out rather than being aspirated.
    • Give high-flow oxygen and use Yankauer suction continuously.
    • Encourage an awake patient to spit blood out. Do not let them swallow it.
    • Keep nil by mouth.
  3. Assess and resuscitate
    • Continuous pulse oximetry, pulse, blood pressure, and frequent reassessment.
    • Obtain large-bore IV access, ideally two lines if substantial bleeding.
    • Send FBC, coagulation studies, group-and-save/crossmatch.
    • Give warmed IV crystalloid initially, and blood products as indicated by clinical shock, ongoing loss, and laboratory results.
    • Remember that children may compensate until late, and swallowed blood can grossly underestimate loss.
  4. Temporary local measures only if safe and experienced
    • Direct pressure to the tonsillar fossa using a swab/gauze on a tonsil artery forceps or Magill forceps.
    • Topical adrenaline-soaked gauze may temporise bleeding while awaiting theatre, but only with suction available and with the patient positioned forward/laterally. It must not delay definitive management.
  5. Definitive haemostasis in theatre
    • General anaesthesia with an experienced anaesthetist, anticipating a full stomach and a blood-contaminated difficult airway.
    • Suction the pharynx, remove clots, identify the bleeding point.
    • Secure haemostasis with bipolar diathermy or ligature/under-running suture. For diffuse tonsil-bed ooze, haemostatic gauze plus bipolar diathermy and suturing the bed may be required.
    • Recheck both fossae carefully before extubation.
  6. After control
    • Close postoperative observation, including airway and haemodynamic monitoring.
    • Correct coagulopathy or other contributors if present.
A small ooze can respond to local pressure, but ongoing bleeding is an indication for urgent return to theatre. Bailey and Love specifically notes that local pressure may help mild cases, whereas early postoperative haemorrhage commonly needs operative control; in theatre, bipolar diathermy, haemostatic gauze, and suturing of the tonsil bed are often effective. Bailey and Love's Short Practice of Surgery, 28th ed., p. 808.
Recent review literature on post-tonsillectomy bleeding protocols is available as PMID 42398383, but it mainly concerns broader postoperative protocols rather than replacing urgent airway control and surgical haemostasis.

2 mark question board exam give only the main step that need to perform

Primary haemorrhage after tonsillectomy:
Immediately control bleeding by pressure with a tonsillar swab, then identify and secure bleeding points with ligation or bipolar diathermy.

Give as 5 step

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  1. Call ENT surgeon and anaesthetist.
  2. Sit patient up, leaning forward; suction blood and give oxygen.
  3. Secure IV access, send blood for grouping/crossmatch, and start IV fluids.
  4. Apply pressure with tonsil swab to control bleeding temporarily.
  5. Return to theatre for haemostasis by ligation or bipolar diathermy.
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