Transport of a patient with massive traumatic epistaxis using a cricket helmet and posterior nasal packing

by Philip V. Alexander, MS and Alka Walters, MS | Monday, June 01, 2009

IntroductionMost traumatic epistaxis is self-limiting and can be controlled simply. Anterior nasal packing, posterior nasal packing, and greater palatine fossa injections have been described.1 Bleeding that is not controlled by these methods necessitates further intervention, such as endoscopic ablation and embolization,2,3 super-selective cauterization,4 endoscopic clipping of the bleeding artery,5 or endoscopic ligation.6 In developing countries, facilities where these procedures can be performed are available only in tertiary care centers, and transport to these centers is not easy in the presence of active bleeding.We describe a patient with a traumatic anterior ethmoidal artery bleed on whom a cricket helmet was used to provide traction after posterior nasal packing with a Foley balloon catheter. The patient survived the 8-hour journey by road to the referral center, underwent endoscopic ablation, and returned safely. We could not find a reference in literature for a similar .../continued/

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