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Estimate blood loss. Assess measured losses, and assume significant proportion of unmeasured losses in stomach. Perform baseline hemaglobin.

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Ensure patient has valid blood group and hold

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Two large bore IVCs. One to administer volume, the other to administer drugs and as a backup volume line.

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Mar 16, 2012
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Avoid dislodging clot during laryngoscopy which could cause bleeding and obscure the airway

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Ensure two airway suction devices are present in case one occludes with blood clot

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Ensure two endotracheal tubes available of desired size in case one is placed in the oesophagus and fills with blood

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Have a low threshold for performing rapid sequence-induction to minimise risk of pulmonary aspiration of any gastric blood.

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Consider tranexamic acid if difficult to control bleeding despite normal coagulation profile and platelets

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Consider antibiotic prophylaxis

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Consider intravenous steroids such as dexamethasone to help minimise post-procedure airway swelling.

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Dexamethasone for airway edema. 0.5-2 mg/kg/day divided QID IV/IM. (stat dose 0.125-0.5mg/kg) refl.in/ck
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Consider criteria for admission to HDU postoperatively. (eg obstructive sleep apnoea for respiratory monitoring)

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If significant airway swelling noted on laryngoscopy, assess prior to extubation to ensure there is a leak around the tube with cuff deflated. If no leak, will require ventilation in ICU until thr swelling subsides.

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