b. Signs/Symptoms. Included are the following:
Position of the nose (appears abnormal; possible deformity of septal
Pain and edema (swelling).
Epistaxis (nose bleed).
(1) Control hemorrhage. Apply cold compresses for mild bleeding and
edema. For anterior bleeding, have the patient press the affected nostril closed with his
fingers and hold the nostril closed for five minutes at a time. Be sure the entire nostril is
pressed closed. Cauterize with electrocautery (cauterizing instrument with platinum
wire, heated by electrical current). If this instrument is not available, cauterize with
silver nitrate. Pack the affected nasal passage with one-half Vaseline impregnated
gauze or antibiotic ointment on gauze. Use antibiotics on gauze if the pack is to remain
in place for forty hours or more. Gauze with antibiotics may be left in place for as long
as five to six days if necessary. For posterior bleeding, anesthetize the area with a
solution of four percent cocaine. Perform posterior packing: a Red Robinson catheter
and nasogastric tube as well as tonsil packing. The patient must be hospitalized and on
complete bed rest. Antibiotics should be given as needed. A patient experiencing
uncontrolled bleeding should be medically evacuated for further electrocautery or
artificial ligation (surgical tying of a blood vessel).
(2) Bone displacement. Determine whether a bone has been moved out of
its proper place by x-ray.
(3) Bone realignment. A bone which is out of its proper position may be
realigned if the patient is given local anesthetic. At a later time, rhinoplasty (plastic
surgery/surgical reconstruction of the nose) can be used to correct an out of place bone.
Bilateral nasal packing.
Insert a catheter in the nostrils.
(b) Draw the catheters through the mouth.
(c) Tie a suture from the pack to each catheter securing the pack in
place. See figure 4-9(A).
Draw the catheters back through the nostrils as shown in figure 4-
(e) Hold the sutures tightly and insert packing into the anterior nose.