Post-tonsillectomy hemorrhage - Revision history

Rossdonaldson1: /* See Also */

2022-11-16T21:09:04Z

Rossdonaldson1: /* Minor Bleeding */

2022-11-16T21:08:47Z

Minor Bleeding

← Revisión anterior		Revisión del 21:08 16 nov 2022
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	*If stable, no active bleeding, and clot is present - do not remove the clot<ref name="Otolaryngologic Procedures">Riviello R. Otolaryngologic Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.</ref>		*If stable, no active bleeding, and clot is present - do not remove the clot<ref name="Otolaryngologic Procedures">Riviello R. Otolaryngologic Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.</ref>
	===Minor Bleeding===		===Minor Bleeding===
	*~~ENT evidence for~~ Hydrogen ~~Peroxide gargle. 50/50 3% Hydrogen Peroxide/Water~~ gargle ~~for 10 minutes.~~ <ref>Hydrogen peroxide as a hemostatic agent in tonsillectomy: Is it beneficial? Thejas Saai Ram, Vinayak Ravindranath, Sindu MohanYear : 2021 \| Volume: 23 \| Issue Number: 1 \| Page: 36-40 </ref>		*Hydrogen peroxide gargle<ref>Hydrogen peroxide as a hemostatic agent in tonsillectomy: Is it beneficial? Thejas Saai Ram, Vinayak Ravindranath, Sindu MohanYear : 2021 \| Volume: 23 \| Issue Number: 1 \| Page: 36-40 </ref>
			**50/50 3% Hydrogen Peroxide/Water gargle for 10 minutes.
	*Can attempt [[benzocaine]] spray or rinse with cold water, [[TXA]], or [[lidocaine]] with epinephrine		*Can attempt [[benzocaine]] spray or rinse with cold water, [[TXA]], or [[lidocaine]] with epinephrine
	*Can also try direct pressure with tonsillar pack or gauze infused with TXA or lidocaine with epinephrine on a long clamp or Magill forceps		*Can also try direct pressure with tonsillar pack or gauze infused with TXA or lidocaine with epinephrine on a long clamp or Magill forceps

Zbuchwald: /* Minor Bleeding */

2022-11-16T19:40:47Z

Minor Bleeding

← Revisión anterior		Revisión del 19:40 16 nov 2022
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	*If stable, no active bleeding, and clot is present - do not remove the clot<ref name="Otolaryngologic Procedures">Riviello R. Otolaryngologic Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.</ref>		*If stable, no active bleeding, and clot is present - do not remove the clot<ref name="Otolaryngologic Procedures">Riviello R. Otolaryngologic Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.</ref>
	===Minor Bleeding===		===Minor Bleeding===
	*~~For minor bleeding try~~ [[benzocaine]] spray or rinse with cold water, [[TXA]], or [[lidocaine]] with epinephrine		*ENT evidence for Hydrogen Peroxide gargle. 50/50 3% Hydrogen Peroxide/Water gargle for 10 minutes. <ref>Hydrogen peroxide as a hemostatic agent in tonsillectomy: Is it beneficial? Thejas Saai Ram, Vinayak Ravindranath, Sindu MohanYear : 2021 \| Volume: 23 \| Issue Number: 1 \| Page: 36-40 </ref>
			*Can attempt [[benzocaine]] spray or rinse with cold water, [[TXA]], or [[lidocaine]] with epinephrine
	*Can also try direct pressure with tonsillar pack or gauze infused with TXA or lidocaine with epinephrine on a long clamp or Magill forceps		*Can also try direct pressure with tonsillar pack or gauze infused with TXA or lidocaine with epinephrine on a long clamp or Magill forceps
	*In desperate situations may need to intubate patient and tightly pack oropharynx to tamponade bleeding
	===Uncontrolled Bleeding===		===Uncontrolled Bleeding===
	''No guidelines provide a stepwise approach so all of these therapies can be attempted in addition to emergent ENT consult aggressive suction, and direct pressure if possible.''		''No guidelines provide a stepwise approach so all of these therapies can be attempted in addition to emergent ENT consult aggressive suction, and direct pressure if possible.''

Rossdonaldson1: /* Clinical Features */

2022-01-06T05:14:16Z

Clinical Features

← Revisión anterior		Revisión del 05:14 6 ene 2022
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	==Clinical Features==		==Clinical Features==
	[[File:PMC4273168 CTO-13-07-g-006.png\|thumb\|Intraoperative image after partial removal of the bilateral tonsils with bleeding controlled.]]		[[File:PMC4273168 CTO-13-07-g-006.png\|thumb\|Intraoperative image after partial removal of the bilateral tonsils with bleeding controlled.]]
			[[File:PMC2848321 ceo-3-56-g001.png\|thumb\|Intraoral photograph showing bleeding from the lower pole of the right tonsil (arrow).]]
	*[[Hemoptysis]]		*[[Hemoptysis]]
	*Recent tonsillectomy		*Recent tonsillectomy

Rossdonaldson1: /* Clinical Features */

2022-01-06T05:12:15Z

Clinical Features

← Revisión anterior		Revisión del 05:12 6 ene 2022
Línea 7:		Línea 7:

	==Clinical Features==		==Clinical Features==
			[[File:PMC4273168 CTO-13-07-g-006.png\|thumb\|Intraoperative image after partial removal of the bilateral tonsils with bleeding controlled.]]
	*[[Hemoptysis]]		*[[Hemoptysis]]
	*Recent tonsillectomy		*Recent tonsillectomy

Rossdonaldson1: /* Background */

2022-01-06T04:59:10Z

Background

← Revisión anterior		Revisión del 04:59 6 ene 2022
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	==Background==		==Background==
			[[File:Gray1014.png\|thumb\|Anatomy of the posterior pharynx.]]
	*Occurs after tonsillectomies in 3.9% of adults and 1.6% of children<ref>Windfuhr JP and Yue-Shih C. Incidence of post-tonsillectomy hemorrhage in children and adults: A study of 4,848 patients. Ear, Nose & Throat Journal. 2002; 81(9):626-628.</ref>		*Occurs after tonsillectomies in 3.9% of adults and 1.6% of children<ref>Windfuhr JP and Yue-Shih C. Incidence of post-tonsillectomy hemorrhage in children and adults: A study of 4,848 patients. Ear, Nose & Throat Journal. 2002; 81(9):626-628.</ref>
	*Most common on POD 5-7		*Most common on POD 5-7

ClaireLewis at 23:47, 14 September 2019

2019-09-14T23:47:07Z

← Revisión anterior		Revisión del 23:47 14 sep 2019
Línea 6:		Línea 6:

	==Clinical Features==		==Clinical Features==
	*Hemoptysis		*[[Hemoptysis]]
	*Recent tonsillectomy		*Recent tonsillectomy
	**Primary post-tonsillectomy hemorrhage from 0-24 hrs		**Primary post-tonsillectomy hemorrhage from 0-24 hrs
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	*If stable, no active bleeding, and clot is present - do not remove the clot<ref name="Otolaryngologic Procedures">Riviello R. Otolaryngologic Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.</ref>		*If stable, no active bleeding, and clot is present - do not remove the clot<ref name="Otolaryngologic Procedures">Riviello R. Otolaryngologic Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.</ref>
	===Minor Bleeding===		===Minor Bleeding===
	*For minor bleeding try benzocaine spray or rinse with cold water, TXA, or lidocaine with epinephrine		*For minor bleeding try [[benzocaine]] spray or rinse with cold water, [[TXA]], or [[lidocaine]] with epinephrine
	*Can also try direct pressure with tonsillar pack or gauze infused with TXA or lidocaine with epinephrine on a long clamp or Magill forceps		*Can also try direct pressure with tonsillar pack or gauze infused with TXA or lidocaine with epinephrine on a long clamp or Magill forceps
	*In desperate situations may need to intubate patient and tightly pack oropharynx to tamponade bleeding		*In desperate situations may need to intubate patient and tightly pack oropharynx to tamponade bleeding
Línea 33:		Línea 33:
	''No guidelines provide a stepwise approach so all of these therapies can be attempted in addition to emergent ENT consult aggressive suction, and direct pressure if possible.''		''No guidelines provide a stepwise approach so all of these therapies can be attempted in addition to emergent ENT consult aggressive suction, and direct pressure if possible.''
	*Nebulized [[Tranexamic acid]] - 250 mg for patients < 25kg and 500mg if > 25kg<ref>Schwarz W. et al. Nebulized Trnexamic acid use for pediatric secondary post tonsillectomy hemorrhage. Annals of Emergency Medicine. 73(3). 2019</ref>		*Nebulized [[Tranexamic acid]] - 250 mg for patients < 25kg and 500mg if > 25kg<ref>Schwarz W. et al. Nebulized Trnexamic acid use for pediatric secondary post tonsillectomy hemorrhage. Annals of Emergency Medicine. 73(3). 2019</ref>
	*Nebulized [[~~racemic~~ epinephrine]] - 0.5 mL of 2.25% solution in 3 mL		*Nebulized racemic [[epinephrine]] - 0.5 mL of 2.25% solution in 3 mL
	*Lidocaine with epinephrine soaked pledgets		*[[Lidocaine]] with epinephrine soaked pledgets
	*Thrombin powder		*Thrombin powder

Ostermayer: /* Uncontrolled Bleeding */

2019-04-12T07:25:15Z

Uncontrolled Bleeding

← Revisión anterior		Revisión del 07:25 12 abr 2019
Línea 32:		Línea 32:
	===Uncontrolled Bleeding===		===Uncontrolled Bleeding===
	''No guidelines provide a stepwise approach so all of these therapies can be attempted in addition to emergent ENT consult aggressive suction, and direct pressure if possible.''		''No guidelines provide a stepwise approach so all of these therapies can be attempted in addition to emergent ENT consult aggressive suction, and direct pressure if possible.''
	*Nebulized [[Tranexamic acid]] - 250 mg for patients < 25kg and 500mg if > 25kg		*Nebulized [[Tranexamic acid]] - 250 mg for patients < 25kg and 500mg if > 25kg<ref>Schwarz W. et al. Nebulized Trnexamic acid use for pediatric secondary post tonsillectomy hemorrhage. Annals of Emergency Medicine. 73(3). 2019</ref>
	*Nebulized [[racemic epinephrine]] - 0.5 mL of 2.25% solution in 3 mL		*Nebulized [[racemic epinephrine]] - 0.5 mL of 2.25% solution in 3 mL
	*Lidocaine with epinephrine soaked pledgets		*Lidocaine with epinephrine soaked pledgets

Ostermayer: /* Uncontrolled Bleeding */

2019-04-12T07:23:14Z

Uncontrolled Bleeding

← Revisión anterior		Revisión del 07:23 12 abr 2019
Línea 34:		Línea 34:
	*Nebulized [[Tranexamic acid]] - 250 mg for patients < 25kg and 500mg if > 25kg		*Nebulized [[Tranexamic acid]] - 250 mg for patients < 25kg and 500mg if > 25kg
	*Nebulized [[racemic epinephrine]] - 0.5 mL of 2.25% solution in 3 mL		*Nebulized [[racemic epinephrine]] - 0.5 mL of 2.25% solution in 3 mL
	*Lidocaine with ~~inephrine~~ soaked pledgets		*Lidocaine with epinephrine soaked pledgets
	*Thrombin powder		*Thrombin powder

Ostermayer: /* Management */

2019-04-12T07:22:59Z

Management

← Revisión anterior		Revisión del 07:22 12 abr 2019
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	** Important things to discuss with ENT: patient age, level of cooperation, visible clot, hematemesis, bleeding diathesis		** Important things to discuss with ENT: patient age, level of cooperation, visible clot, hematemesis, bleeding diathesis
	*If stable, no active bleeding, and clot is present - do not remove the clot<ref name="Otolaryngologic Procedures">Riviello R. Otolaryngologic Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.</ref>		*If stable, no active bleeding, and clot is present - do not remove the clot<ref name="Otolaryngologic Procedures">Riviello R. Otolaryngologic Procedures. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.</ref>
			===Minor Bleeding===
	*For minor bleeding try benzocaine spray or rinse with cold water, TXA, or lidocaine with epinephrine		*For minor bleeding try benzocaine spray or rinse with cold water, TXA, or lidocaine with epinephrine
	*Can also try direct pressure with tonsillar pack or gauze infused with TXA or lidocaine with epinephrine on a long clamp or Magill forceps		*Can also try direct pressure with tonsillar pack or gauze infused with TXA or lidocaine with epinephrine on a long clamp or Magill forceps
	*In desperate situations may need to intubate patient and tightly pack oropharynx to tamponade bleeding		*In desperate situations may need to intubate patient and tightly pack oropharynx to tamponade bleeding
			===Uncontrolled Bleeding===
			''No guidelines provide a stepwise approach so all of these therapies can be attempted in addition to emergent ENT consult aggressive suction, and direct pressure if possible.''
			*Nebulized [[Tranexamic acid]] - 250 mg for patients < 25kg and 500mg if > 25kg
			*Nebulized [[racemic epinephrine]] - 0.5 mL of 2.25% solution in 3 mL
			*Lidocaine with inephrine soaked pledgets
			*Thrombin powder

	==See Also==		==See Also==

← Revisión anterior		Revisión del 21:09 16 nov 2022
Línea 43:		Línea 43:

	==See Also==		==See Also==
	[[Pharyngitis]]		*[[Pharyngitis]]

	==References==		==References==