“If you put a big tube in, then as soon as possible, see if you can exchange it for a smaller one,” Dr. Sims said. “If it’s still needed after 48 hours, consider converting to a trach.”
Explore this issue:June 2013
Bleeds are far more common in office than airway obstructions. Some patients experience excessive bleeding during an office procedure; others walk in with uncontrolled epistaxis. In both cases, the goal remains the same: Control the bleeding.
All otolaryngology offices should have nasal packing material on hand. Dr. Zandifar also recommends pro-coagulating material such as Floseal and Gelfoam. Cautery equipment is also useful, as is a blood pressure monitor. Some offices also have intravenous supplies ready, in case the patient needs IV hydration to restore fluid volume.
Careful preparation may decrease the number of bleeding incidences you experience—and increase your ability to handle them efficiently.
“I’ve found that talking to my patients, letting them know that there may be some bleeding but that they’re okay, makes patients more comfortable and decreases their blood pressure, which definitely helps with bleeding,” Dr. Zandifar said.
It’s also helpful to expect bleeding. “When a patient comes in after an ER visit and needs nasal packing removed, I never approach it as, ‘I’m going to take this out, and it’s going to be fine.’ I always approach it thinking, ‘I’m going to take this out, and they’re going to bleed on me,’” Dr. Zandifar said. “I wear a gown and face shield and have the patient wear a gown. And I have all the equipment I might need right there—a headlight, cautery equipment, packing material. If I take the packing out and nothing happens, great. But if the patient bleeds, I definitely don’t want to be underprepared.”
If possible, have an assistant in the room with you. The assistant can hand you supplies and escort out family members, if necessary.
Otolaryngology offices that offer allergy services must be prepared for the possibility of an allergic reaction. “If you’re going to be doing allergy shots in your practice, or if you’re going to be escalating immunotherapy, it’s important to have a trained physician on site at all times who can handle an emergency,” Dr. DeSilva said. “If someone has an acute allergic reaction, you don’t want to leave a patient with a technician who doesn’t know how to handle those types of situations.”