Emergency surgery after a tonsillectomy

A nurse anesthetist acts quickly when a child begins coughing up copious amounts of blood after a routine procedure.

Emergency surgery after a tonsillectomy and adenoidectomy
Emergency surgery after a tonsillectomy and adenoidectomy

April was a sweet 4-year-old patient, who needed a tonsillectomy and adenoidectomy. I frequently worked with Dr. P, an ear, nose and throat specialist, administering anesthetics to his patients. April's procedure went smoothly, as well as her emergence from the anesthetic.

After leaving April in the post-anesthesia nurse's care, I went to the family waiting room and informed her parents she had tolerated the anesthetic well and was resting quietly. They said they appreciated the time I took to inform them of April's condition.

That evening I was the in-house call anesthetist and answered a page from the pediatric ward requesting I come STAT to room 510. I ran up the two flights of stairs and down the hall to April's room. The emergency light was flashing, and upon entering, a nurse was trying to calm a crying frightened child, who was spitting and coughing up copious amounts of bright red blood.

I immediately looked into April's mouth and saw blood spurting from the left side. I jumped on the bed over her and put my finger into her mouth, holding pressure hard on the bleeding area. Luckily, the bleeding was under control with the pressure.  

I instructed the nurse to call Dr. P and tell him April was hemorrhaging and needed immediate surgery. Along with Dr. P, she also needed to call in the surgery team and Dr. Y, the anesthesiologist on call. Then she needed to order a type and cross match for one unit of blood.

At that moment, April's mother came into the room and took one look at the blood soaked sheet and then at me. She had a look of panic that I understood well, as the mother of a daughter the same age as April. I told her April needed surgery to stop the bleeding, and everything was in progress to take her to the operating room immediately.

I then instructed the nurses to push the bed, as I continued holding pressure in April's mouth. I asked her mother to accompany us on the elevator until we reached the OR suite in hopes that it would ease her anxiety.

As the sliding door to the OR suite opened, Dr. P and Dr. Y came in from a side door. I said a prayer of thanks that both of them lived just blocks from the hospital. Dr. Y and I gave a rapid sequence induction, and soon April was anesthetized with Dr. P holding pressure to the pumping artery.

Six hours later appropriate blood had been transfused, a branch of the left external carotid artery was ligated, and finally the bleeding stopped. April's emergence and recovery went well, and two days later she was discharged.

Several weeks later, I received an envelope addressed to me at the hospital. A crayon drawing by a small child was enclosed. It depicted two stick figures, a nurse and a child, holding hands with the message: "Thanks for saving me. Love, April."

Thirteen years later I received another envelope with a high school graduation announcement enclosed, and another thank you note from April.

Monica Heseman, CRNA, practices in Jacksonville, Florida.


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