These resources give you a plan on what to do for the patient while awaiting the ENT surgeon and anesthesiologist to arrive and take the patient to the OR.
In this post I link to three great resources on post-tonsillectomy bleeding:
- Massive Hemorrhage Post-Tonsillectomy from Dr. Justin Morgenstern of First10EM, Published August 6, 2018-Updated October 11, 2018.
- Post-Tonsillectomy Hemorrhage from Pediatric EM Morsels, by Dr. Sean Fox, AUGUST 17, 2012
- Post tonsillectomy hemorrhage (Re-post) from PEMBLOG, by Dr. Brad Sobolewski|January 24th, 2017
If the patient has copious bleeding before the ENT physician and anesthesiologist arrive, then direct pressure on the bleeding tonsillar fossa will be necessary as detailed in Massive Hemorrhage Post-Tonsillectomy from Dr. Justin Morgenstern of First10EM, Published August 6, 2018-Updated October 11, 2018.
And direct pressure will almost certainly require sedation.
Here are some resources on ketamine sedation:
See Clinical Procedure Guidelines Ketamine use for procedural sedation from The Royal Children’s Hospital Melbourne.
The use of ketamine sedation requires that the clinician be able to proceed to rapid sequence intubation if necessary.
See Managing laryngospasm in the emergency department from First10EM by Dr. Justin Morgenstern|Published March 3, 2016-Updated January 13, 2019