A previously irradiated laryngectomy patient has a small self-limiting bleed from a fungating neck wound. CT angiography shows carotid exposure and a pseudoaneurysm. The patient is currently stable. What is the priority?
A herald bleed with an exposed irradiated carotid and pseudoaneurysm predicts catastrophic haemorrhage; airway, large-bore access, blood, goals of care and urgent vascular control must be coordinated.
A. Treat this as a sentinel bleed and obtain urgent endovascular and head-and-neck rescue planning: A herald bleed with an exposed irradiated carotid and pseudoaneurysm predicts catastrophic haemorrhage; airway, large-bore access, blood, goals of care and urgent vascular control must be coordinated.
B. Discharge because bleeding has stopped: Temporary cessation is characteristic of a sentinel bleed and does not reduce the imminent risk.
C. Pack the wound blindly at the bedside: Uncontrolled manipulation can precipitate exsanguination and packing may not control an arterial defect.
D. Book routine wound debridement next month: The vascular emergency precedes elective wound management.
E. Commence anticoagulation for the pseudoaneurysm: This would increase haemorrhage risk and does not secure the vessel.
If torrential bleeding began, immediate resuscitation, airway protection where feasible, direct pressure/packing and emergency vascular control would supersede further diagnostic work-up.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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