A 3-year-old child undergoes adenotonsillectomy for recurrent tonsillitis. In the immediate post-operative period (within 24 hours), she develops profuse bleeding from the mouth. The most appropriate first management step is:

• A Observation and administration of tranexamic acid
• B Immediate return to theatre for ligation under general anaesthesia
• C Local pressure with adrenaline-soaked gauze in the ward
• D Resuscitation with IV fluids and blood, then return to theatre ✓

Explanation

Primary reactionary haemorrhage post-tonsillectomy (within 24 hours) requires immediate resuscitation — IV access, fluids, cross-match, and haemodynamic stabilization — before returning to theatre for haemostasis under GA. In a young child, even modest blood loss relative to body weight can cause significant haemodynamic compromise. Operating on an unresuscitated, haemodynamically unstable child under GA is dangerous. Simple ward measures are inadequate for significant bleeding requiring surgical control.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.