T&A Bleed, Post Op — History and Physical Examination — Clinical Pathway: Emergency

T&A Post-Op Bleed Clinical Pathway — Emergency Department

History and Physical Examination

Secondary hemorrhage occurs most commonly 5-10 days following surgery

Risk factors include:

  • Age > 6 yrs
  • BMI > 95 percentile
  • Procedure performed for OSA

Post-operative hemorrhage usually stops spontaneously, however:

  • 1-6% require OR for cauterization
  • Majority requires 12-24 hrs of observation

Blood transfusion is rarely necessary

Active bleeding complicates airway management

Estimating blood loss is challenging as large amounts may be swallowed

General
  • Date of T&A surgery
  • Assess bleeding
    • Volume (teaspoon, ounce, cup)
    • Duration (< 1 min)
    • Number of episodes
    • Time of last episode
  • Time of last oral intake
  • Fever, increased pain
Medications, Allergy
  • Current medication
  • Recent ibuprofen, aspirin
  • Last dose of ibuprofen, acetaminophen, celecoxib
  • Dexamethasone use
PMH
  • Difficult/critical airway
  • Coagulopathy
Physical Examination