Emergency Medicine Cases EM Quick Hits 60 Post-Tonsillectomy Hemorrhage, Post-CABG Infections, Bougie Tips, Pelvic Fracture Bleeds, Debriefing: Why, When & How
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Oct 22, 2024 
Kevin Wasko, Chief of the ED at North York General Hospital, shares insights on managing post-tonsillectomy hemorrhages. Brit Long discusses critical strategies for assessing and managing post-CABG incision infections. Anand Swaminathan provides expert tips on using gum elastic bougies for airway management. Leah Flannigan highlights the importance of identifying vascular injuries in pelvic fractures. Andrew Petrosoniak emphasizes the value of debriefing in trauma resuscitations, enhancing team performance and patient outcomes.
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Post-Tonsillectomy Bleed Management
- Post-tonsillectomy bleeds can be primary (within 24 hours) or secondary (after 24 hours).
- Get ENT involved early, regardless of bleeding severity, as definitive care is always needed.
Three-Pronged Approach to Bleeds
- Manage post-tonsillectomy bleeds with a three-pronged approach: resuscitation, early ENT consultation, and temporizing measures.
- Temporizing measures include direct pressure, topical agents like epinephrine, and TXA (IV, topical, or nebulized).
Airway Management and Bleeding Disorders
- For airway compromise, use an RSI approach with video laryngoscopy and suction.
- Consider DDAVP for younger patients with unexpected bleeding, suspecting undiagnosed von Willebrand's disease.