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
  • 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
EDECU admit criteria
Admit ENT Service
Observation, OR as indicated
OR as soon as available
  • 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