Post-Tonsillectomy Hemorrhage in a 7-Year-Old on POD #6
Post-Tonsillectomy Hemorrhage in a 7-Year-Old on POD #6 - Otolaryngology (ENT) clinical simulation case. A 7-year-old boy, postoperative day 6 from...
Age: 7 • Gender: Male • Setting: Emergency Triage
Clinical Presentation & History
A 7-year-old boy, postoperative day 6 from elective tonsillectomy ± adenoidectomy, brought in by ambulance after his mother witnessed a gush of bright red blood from the mouth followed by intermittent vomiting of dark clotted blood. He is pale, tachycardic, anxious, and intermittently spitting fresh blood into a kidney basin.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
The classic re-bleed timing after post-tonsillectomy hemorrhage repair is 24 hours and 5–10 days post-op; PICU monitoring for 24 hours catches the first peak.
Direct topical pressure with tranexamic acid pledget is the single most effective bedside maneuver before theater.
Avoid awake instrumentation, supine positioning, premature NG lavage, and discharge with ongoing bleeding.
Balanced resuscitation (20 mL/kg crystalloid + early blood products + TXA) beats vasopressor-first or 30 mL/kg bolus approaches in children.
Any child who vomits dark blood after tonsillectomy has swallowed a significant volume; do not underestimate total blood loss from Hb alone.
Test Your Clinical Reasoning in Real Time
Step into the active clinician role for this case. Order diagnostic tests, analyze live laboratory panels, and navigate branching clinical decisions with real-time feedback.