Treatment
1.Control the shock:
a.supine position with leg elevation : (sedation-warmth-IV fluids-blood transfer)
b.monitoring the patient: (vital sign-blood gases-hematocrite)
2.1st aid measures:
a.patient is sitting and leaning forward and keep head elevation but not hyper extented.
b.dirct pressure in nostrils for 5-10 min [ it work for 90%]
c.local vasoconstrictors and humidity air.
3. cauterization
a.electrocautery: under general or local anesthesia.
b.chemical cautery: silver nitrate or chromic acid.
4.anterior nasal pack
a.merocel sponge, vaseline guase
b.removal after 1-2 day.
5.post nasal pack
a.inflatable ballons or rolled guaze
b.1-2 days.
6.surgical treatment:
a.endoscopic diathermy for sphenopaltine and anterior ethmiodal arteries.
b.embolization with selective angiography may be helpful.
c.ligation:
1.internal maxillary and external carotid arteries :if bleeding occur post from below the middle turbinate.
2.anterior and posterior ethmoidal artery: if bleeding occur superior above middle turbinate.
7.general treatment:
a.rest in bed and sedation.
b.vit k in prothrombin deficiency.
c.vit c aid capillary wall integrity
8.causal treatment : after treatment the cause
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