A child presents seven days after tonsillectomy with repeated swallowing, pallor and fresh blood in the mouth. What is the safest immediate management?
Secondary post-tonsillectomy haemorrhage may be underestimated because blood is swallowed. IV access, blood tests, resuscitation, senior airway planning and operative haemostasis must not be delayed.
A. Resuscitate, keep nil by mouth and obtain urgent ENT and anaesthetic control: Secondary post-tonsillectomy haemorrhage may be underestimated because blood is swallowed. IV access, blood tests, resuscitation, senior airway planning and operative haemostasis must not be delayed.
B. Examine the throat repeatedly with a tongue depressor: Agitation and clot disruption may precipitate major bleeding.
C. Discharge if bleeding pauses: A sentinel bleed can recur catastrophically.
D. Give oral fluids to assess swallowing: Aspiration and operative risks require fasting.
E. Treat with oral antibiotics alone: Infection may contribute, but haemorrhage control is the priority.
If the child became haemodynamically unstable, major-haemorrhage resuscitation and immediate theatre transfer would proceed simultaneously.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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