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January 20, 1969

Death and Epistaxes

Author Affiliations

Beekman-Downtown Hospital New York

JAMA. 1969;207(3):562. doi:10.1001/jama.1969.03150160074026

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To the Editor:—  Physicians think of clotted blood as a hazard largely in intravascular areas; they welcome clot formation when faced with internal or surface bleeding. The lowly epistaxis is passed over hurriedly but it can, unnoticed, quietly suffocate the patient.

Report of Cases:— 

  1. Emergency resuscitation after trauma to the head led to the discovery of a large blood clot overlying the larynx, with recovery of respiratory function following removal.

  2. Marked narrowing of tracheal and bronchial airways by a thick layer of clotted fibrin and blood was found at autopsy in a man who died in uremic coma.

  3. A similar massive clot was found in the posterior portion of the pharynx of a man who died in hepatic coma.

  4. Nasal packing for epistaxis resulted in the accumulation of a mass of clotted blood in the trachea and larynx with increasing respiratory distress. A large mass of