Tonsillar bleeding

Question 1

6 year old jehova’s witness with 2ry HGE ( POD6) after tonsillectomy HR is 120 , but is stable now .

Q1. If HG is 7.4, will you give blood ?

Answer 1

No
I will assess pt condition and start him on fluids until getting consent from parents, if refuse –> advice from legal team and my consultants.

Question 2

Q2: How will you manage the airway ?

Answer 2

Assess patency of it by Look, Feel, Listen and call help from ENT
removal of FB or blood clot by suction of open airway
Chin left jaw thrust to maintain airway open
Failed – > Oro/Nasopharyngeal airways and oxygenation
Failed – > intubation by Expert

Question 3

Q3. How to stop bleeding in theater ?

Answer 3

Packing with adrenaline soaked gauze / surgical / gel foam
use medications
use diathermy
Last opt; ECA ligation if not controlled

Question 4

Q4: Type of diathermy you use ?

Answer 4

Bipolar

Question 5

Q5: Which medication will help ? Dose?

Answer 5

Tranexamic acid 10-15mg/kg

Question 6

Q6. What will you look for when patient is in recovery ?

Answer 6

Hb level / check surgical site again

Question 7

Q7 : Calculate bolus dose of fluid ?

Answer 7

Glucose free crystalloids that contain Na (131-154mmol) 20ml/Kg over less than 10 mins

Question 8

Q8. Calculate the maintenance dose of fluid ?

Answer 8

Holiday-segar formula 100 ml/kg /24hr for first 10kg then 50 ml for 2nd 10kg then 20ml for the rest
Surface area 300-400 ml/m2/24hrs

Question 9

Q9. How will you make sure you are operating on the correct patient ?

Answer 9

WHO Checklist

Question 10

Q10. What is sign in , time out and sign out ?

Answer 10

Sign in; before induction of anathesia
Time out; before skin incision
Sign out; before pt leaving OR