12 การรักษาพยาบาลเบื้องต้น (ต่อ) Cold compressจี้ด้วยไฟฟ้า หรือ Trichloracetic acid 30%Anterior nasal packing ด้วย Gel foamหรือ Finger cot หรือ Vaseline gauzeMouth care and Rest งดการสั่งน้ำมูกแรงๆ
13 Visualization of the nose without topical anesthesia and decongestant will result not only in severe discomfort for the patient, but also possibly precipitate additional bleeding. Spending the extra several seconds or so to anesthetize and decongest the nose will dramatically decrease the discomfort experienced by the patient.
21 After you place and expand an expandable methylcellulose nasal pack in her nose she continues to bleed. Blood is only oozing from her nose but she is still spitting out bright red blood and clots from her mouth.
31 She was admitted to the ICU, monitored and sedated. Urgent referral to an ENT made for definitive treatment.Later that afternoon she is transferred to the otolaryngologist in the adjacent town. The following day you receive a call from him and are told that she rebled during the night. He is planning to take her to the operating room urgently to perform endoscopic clipping of the sphenopalatine artery.
32 Endoscopic clipping of the sphenopalatine artery.
33 Later that day you receive another call from the otolaryngologist Later that day you receive another call from the otolaryngologist. Following uneventful endoscopic ligation of the sphenopalatine artery the bleeding continued so he clipped the anterior ethmoid artery as well.
34 Ligation blood vessel Anterior ethmoid a. Posterior ethmoid a. Internal maxillary a.External carotid a.