Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Post-Op Tonsillectomy and Adenoidectomy (T&A) Bleed
- Estimate blood loss
- Vital signs, mental status
- Evaluate for:
- Tonsillar bleeding
- Tonsillar clot
- Presence of eschar
- NPO
- Avoid unnecessary suctioning
- Labs, IVF:
- CBC
- BMP, as indicated
- NS bolus, repeat as indicated
- Maintenance IVF, as indicated
No Active Bleeding
Active Bleeding
History of minimal blood loss and no tonsillar clot present
Tonsillar clot present or
> 1 episode of bleeding
> 1 episode of bleeding
- Resuscitation room
- Immediate ENT Consult
- Oxymetazoline for nasal bleeding
- PRBC transfusion, as indicated
- Prepare LMA
- Consider difficult airway cart
- Place 2 IVs
- Additional labs
- PT/PTT, T&C
- Notify OR 5-4444
ENT Consult
- Urgent ENT Consult
- Additional Labs
- T&C if Hgb 10 mg/dL
- Bag and mask at bedside
Discharge
EDECU admit criteria
Admit ENT Service
Observation, OR as indicated
Observation, OR as indicated
OR as soon as available
- Well-appearing
- Stable Hgb, vital signs
- Tolerating PO
- Age > 2 yrs
- Discharge Instructions
- No current bleeding
- Minimal blood loss per ENT
- No clot
- Stable Hgb, vital signs
- No coagulopathy
Posted: July 2008
Revised: March 2023
Authors: J. Lavelle, MD; C. Jacobstein, MD; T. Giordano, DNP; S. Wells, RN; K. Dedhia, MD
Revised: March 2023
Authors: J. Lavelle, MD; C. Jacobstein, MD; T. Giordano, DNP; S. Wells, RN; K. Dedhia, MD