Patients rarely develop shock from facial bleeding. In hypotensive patients, look for other sources of blood loss, such as intrathoracic, intraabdominal, and retroperitoneal hemorrhage. Control maxillofacial bleeding with direct pressure, and avoid blind clamping in wounds, because important structures such as facial nerve or parotid duct may be injured. Severe pharyngeal bleeding may require packing of the pharynx and hypopharynx around a cuffed endotracheal tube. In patients with LeFort fractures, manual reduction of the face should stem bleeding. Grasp the anterior hard palate at the maxillary arch and realign the fragments.
Severe nasal bleeding requires direct pressure to the nares, or combined posterior and anterior packing, taking care not to pack the cranium. In the case of massive nasopharyngeal bleeding, a Foley catheter placed along the floor of the nose and inflated with saline may be lifesaving. Nasopharyngeal dual-lumen balloons are commercially available for this purpose.
Once the airway is secure and gross hemorrhage controlled, only then search for life threats in the chest, abdomen, and pelvis.
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