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December 21st, 2005

Transport of a patient with massive epistaxis

Most traumatic epistaxis is self-limiting and can be controlled simply. Anterior nasal packing, posterior nasal packing and greater palatine fossa injections have been described1. Bleeding that is not controlled by these measures necessitate further intervention, endoscopic ablation and embolisation2. In developing countries, these facilities are available only in tertiary care centres. In the presence of active bleeding transport to these centres is not easy. We describe a patient with traumatic anterior ethmoidal artery bleed where a cricket helmet was used to provide traction after posterior nasal packing with a Foleys balloon catheter. The patient survived the eight-hour journey by road to the referral centre, was embolised endoscopically and returned safely. We could not find a reference in literature for a similar transport modality.