The general directions to be given to the patient, though apparently
trivial, are most important and should never be forgotten. He or she
should be advised to go home very quietly, to avoid all forms of
excitement, to assume the sitting position usual during the day, and to
use a high pillow at night. The patient should be fed through a bent
tube, and all fluids should be given cold.
In addition to plugging the socket, hæmostatics should be administered
internally.
In _cases where there is_ a thin watery blood and _no tendency to
coagulation_ it may be fairly assumed that the cause of the hæmorrhage
lies in the blood, and such drugs as gallic acid[11] and perchloride of
iron[12] are indicated, _but when the blood shows a marked tendency to
coagulate_ in the mouth, as often happens, and the bleeding still
continues, such drugs as ergot[13] are indicated; in this latter
condition it may be assumed that the cause of the hæmorrhage lies in
some want of contractility of the vessel wall, and ergot causes
contraction of unstriped muscular tissue.
At the time of plugging the socket a dose of gallic acid, perchloride of
iron or ergot should be given, and its administration continued at
intervals until the bleeding ceases. Mr. Morton Smale prefers a
hypodermic injection of ergotine.[14]
The patient should be seen within twenty-four hours after treatment, and
if the bleeding has ceased the plugs may be removed and an antiseptic
mouth wash prescribed. This course is not recommended when the
hæmorrhage has been severe; under such circumstances the plugs should be
allowed to work themselves out. If the hæmorrhage has not then ceased,
the socket should be replugged tighter than before with a plug of wood
wrapped in non-absorbent cotton-wool. Should this prove of no avail the
actual cautery may be tried; if this fails, and the bleeding is from the
mandible, the canal should be trephined and a plug of ivory inserted,
so as to compress the artery against the inner plate of the bone. In
uncontrollable hæmorrhage from the maxilla digital pressure on the
common carotid opposite the transverse process of the sixth cervical
vertebra may be tried; should this fail to stop the hæmorrhage, ligature
of that vessel must be resorted to.
In one case of hæmorrhage from the region of the third right lower molar
Mr. Boyd[15] divided the lip in the median line and reflected the cheek
from the jaw. The mandibular canal was then laid open by excising the
outer plate of the bone, and the bleeding was arrested by plugging the
mesial and distal ends of the canal.
_In extreme cases, with sign of collapse_, normal saline solution[16]
must be infused into the median basilic vein.
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