- http://www.clinicaljunior.com/entoncalltonsilbleed.html
The advice here is a little old, but I'm sure it's not changed much. I'm not sure how quickly I'd find the hydrogen peroxide mouthwash in a hurry!
- http://www.sthk.nhs.uk/library/documents/posttonsillectomybleeding.pdf
Topical adrenaline is always useful for bleeding - this site advocates McGill's to reach in to the bleeding point. They also advocate giving antibiotics. - http://pedemmorsels.com/post-tonsillectomy-hemorrhage/
PED morsels are always very thorough, and they don't disappoint this time. They have an in-depth review of the anatomy of the tonsils, together with some suggestions on how to stop the bleeding. Importantly, they also highlight what you expect normal tonsils to look like once they've been removed... - http://www.ncbi.nlm.nih.gov/pubmed/23881651?dopt=Abstract
Interestingly, NSAIDs might increase the risk of bleeding. But we can continue to give them anyway. - http://0-pediatrics.aappublications.org.wam.leeds.ac.uk/content/130/2/324.full.pdf+html
Unfortunately this journal article needs a password but is a really useful overview. It talks (amongst other things) about the fibrin clot sloughing off at about a week post-op, which is the high risk time for bleeding. Antibiotics and gargles don't control this fibrin clot formation.
I'm now also going to ask anyone I see with post tonsillectomy bleeding whether they've been eating "sharp edged foods". - http://bestbets.org/bets/bet.php?id=1313
There is minimal evidence base for nebulised adrenaline
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Monday, 29 July 2013
Post Tonsillectomy Bleeding
There are lots of websites that give advice about post tonsillectomy bleeding. All their advice seems sensible, and quite thorough:
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