A 10-year-old presents on day 6 after tonsillectomy after vomiting blood. They are pale and repeatedly swallowing, but the tonsillar fossae appear dry. What is the best response?
Children may swallow substantial blood and compensate before hypotension; apparent cessation does not remove rebleeding and airway risk.
A. Discharge because no bleeding is visible: A dry snapshot is unsafe after a convincing haemorrhage.
B. Remove any clot in the emergency department: Dislodging tamponade may provoke uncontrolled bleeding.
C. Treat as active occult haemorrhage, resuscitate and involve senior ENT and anaesthesia: Children may swallow substantial blood and compensate before hypotension; apparent cessation does not remove rebleeding and airway risk.
D. Give food to test stability: The child should remain nil by mouth for possible theatre.
E. Wait for haemoglobin before obtaining senior help: Acute haemoglobin can be misleading and escalation is time-critical.
If brisk bleeding and shock developed, activate paediatric major haemorrhage and proceed to urgent operative control.
Independent Clinora preparation material; not official JCIE content, an accredited programme or a substitute for local policy and specialist judgement.
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