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Post tonsillectomy hemorrhage

Posted by ringwall @ringwall, Apr 16, 2022

I am a paramedic and I recently brought in an adult patient, 33 male, with a light post tonsillectomy bleed. We reported he had lost an estimated 9 percent of his blood already as he had been bleeding at home for hours. The doctor gave him Tranexamic acid and left the patient unsupervised in a room by himself, where he began to choke and cough and eventually the hemorrhage became significantly worse. I was under the impression that cauterization is the definitive treatment for this kind of injury. Has anyone here ever heard of using TXA as a sole treatment for a serious uncontrolled hemorrhage? I am curious.

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Mentor
John, Volunteer Mentor | @johnbishop | Apr 16, 2022

Welcome @ringwall, I have no medical training or background but found a few references on your question that might be helpful.

"At what rate is tranexamic acid TXA administered in patients with uncontrolled external hemorrhage following blood administration?
The TXA infusion rate should not exceed 1.5 milligrams per kilogram per minute or a maximum of 100 milligrams per minute. Injections above 50 milligrams per minute can cause dizziness and/or hypotension. Jun 29, 2015" -- Tranexamic Acid (TXA): Drug Whys: https://www.ems1.com/ems-products/ambulance-disposable-supplies/articles/tranexamic-acid-txa-drug-whys-JHdJgbiQRX2zqonO/

Association Between Prehospital Tranexamic Acid Administration and Outcomes of Severe Traumatic Brain Injury: https://jamanetwork.com/journals/jamaneurology/fullarticle/2773529

Did you get a chance to followup with the doctor to see if they could provide any insight to the treatment?

REPLY
1 reply
ringwall | @ringwall | Apr 17, 2022
In reply to @johnbishop "Welcome @ringwall, I have no medical training or background but found a few references on your..." + (show)
@johnbishop

Welcome @ringwall, I have no medical training or background but found a few references on your question that might be helpful.

"At what rate is tranexamic acid TXA administered in patients with uncontrolled external hemorrhage following blood administration?
The TXA infusion rate should not exceed 1.5 milligrams per kilogram per minute or a maximum of 100 milligrams per minute. Injections above 50 milligrams per minute can cause dizziness and/or hypotension. Jun 29, 2015" -- Tranexamic Acid (TXA): Drug Whys: https://www.ems1.com/ems-products/ambulance-disposable-supplies/articles/tranexamic-acid-txa-drug-whys-JHdJgbiQRX2zqonO/

Association Between Prehospital Tranexamic Acid Administration and Outcomes of Severe Traumatic Brain Injury: https://jamanetwork.com/journals/jamaneurology/fullarticle/2773529

Did you get a chance to followup with the doctor to see if they could provide any insight to the treatment?

Jump to this post

I was able to follow up, and the treatment was completely ineffective, eventually making things much worse. The doctor maintains that he did the right thing. I posted here hoping to here from some other doctors as to how they would have treated him and if they think TXA is an appropriate sole treatment. I couldn't find any studies supporting this, and a few doctors I've spoken to say that they have never heard of it being used this way.

REPLY
1 reply
Amanda Roe | @amandajro | Apr 17, 2022
In reply to @ringwall "I was able to follow up, and the treatment was completely ineffective, eventually making things much..." + (show)
@ringwall

I was able to follow up, and the treatment was completely ineffective, eventually making things much worse. The doctor maintains that he did the right thing. I posted here hoping to here from some other doctors as to how they would have treated him and if they think TXA is an appropriate sole treatment. I couldn't find any studies supporting this, and a few doctors I've spoken to say that they have never heard of it being used this way.

Jump to this post

Hello @ringwall. First, it is obvious what care and concern you have for your patients. You are definitely in the right field of work and they are lucky to have you in unlucky circumstances.

That said, and just so you aren't left waiting, this is a community made up of patients who offer to share their experiences with others, rather than doctors.

Do you know how your patient faired after all?

REPLY
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