Airway management as needed (anticipate difficulty and have surgical back up)
IV, O2, Monitor, NPO, upright position
ENT consult: Always, re-bleeding is common and may require surgical management
Important things to discuss with ENT: patient age, level of cooperation, visible clot, hematemesis, bleeding diathesis
If stable, no active bleeding, and clot is present - do not remove the clot
Important things to discuss with ENT: patient age, level of cooperation, visible clot, hematemesis, bleeding diathesis
For minor bleeding try benzocaine spray or rinse with cold water, TXA, or lidocaine with epinephrine
Can also try direct pressure with tonsillar pack or gauze infused with TXA or lidocaine with epinephrine on a long clamp or Magill forceps
In desperate situations may need to intubate patient and tightly pack oropharynx to tamponade bleeding
No guidelines provide a stepwise approach so all of these therapies can be attempted in addition to emergent ENT consult aggressive suction, and direct pressure if possible.
Nebulized Tranexamic acid - 250 mg for patients < 25kg and 500mg if > 25kg
Nebulized racemic epinephrine -  0.5 mL of 2.25% solution in 3 mL
Lidocaine with epinephrine soaked pledgets
Thrombin powder
Post-tonsillectomy hemorrhage
Post-op pain
Carotid-cavernous fistula
Streptococcal pharyngitis 
Nasal septal hematoma
Neisseria gonorrhoeae
Vertebral and carotid artery dissection
Diphtheria 