- 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
Welcome
I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.
Please comment with corrections, additions and further suggestions.
All the information here is collected from the internet, and it might be out of date or inaccurate, so please use your judgement and adhere to your hospital's protocols. If you do notice any errors or omissions please comment so we can put them right!
To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.
Please comment with corrections, additions and further suggestions.
All the information here is collected from the internet, and it might be out of date or inaccurate, so please use your judgement and adhere to your hospital's protocols. If you do notice any errors or omissions please comment so we can put them right!
To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.
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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