Tonsillectomy and adenoidectomy are among the most frequent pediatric surgical procedures performed in the United States. Approximately 5% of patients will experience a post-tonsillectomy hemorrhage. Due to the risk of recurrence, even resolved bleeds require otolaryngology consultation. Nearly 30% of patients will have a second bleed. Approximately 40% of second bleeding episodes occur the day following the initial bleed and 10% of all patients with minor bleeding develop severe bleeding. Patients presenting with active bleeding constitute a surgical emergency. Initial assessment and primary survey should prioritize airway management and hemodynamic stability.