Answer C ----.> good visualization of the hemorrhaging area
Even after primary hemostasis has been achieved, patients occasionally return to the dentist with bleeding from the extraction site, so-called secondary bleeding. ( I am interpreting post surgical bleeding with secondary bleeding) The surgeon must have an orderly, planned regimen to control this bleeding. The patient should be positioned in the dental chair, and all blood, saliva, and fluids should be suctioned from the mouth. The surgeon should visualize the bleeding site carefully with good light to determine the precise source of bleeding. If it clearly seen to be a generalized oozing,, the bleeding site is covered with a folded, damp 2 - by 2 inch sponge held in place with firm pressure for at least 5 minutes. This measure is sufficient to control most bleeding. The reason for bleeding is usually some secondary trauma that is potentiated by the patient’s continuing to suck on the area or spit blood from the mouth instead of continuing to apply pressure with a gauze.
If 5 minutes of this treatment does not control the bleeding, the surgeon must administer a local anesthetic so that the socket can be treated more aggessively. Block techniques are to be encouraged instead of local infiltration techniques. Infiltration with solutions containing epinephrine cause vasoconstriction and may control the bleeding temporarily. However, when the effects of the epinephrine dissipate, the may be rebound hemorrhage with recurrent bleeding.
Once local anesthesia has been achieved, the surgeon should gently curette out the tooth extraction socket and suction all areas of old blood clot. The same measures described for control of primary bleeding should be employed. The surgeon should decide if a hemostatic agent should be inserted into the bony socket. The use of an absorbable gelatin sponge with topical thrombin held in position with a figure eight stitch and reinforced with application of firm pressure from a small, damp gauze is standard for local control of secondary bleeding.
If hemostasis is not achieved by any of the local measures, the surgeon should consider performing additional laboratory screening tests to determine if the patient has a hemostatic defect.
Contemporary Oral and Maxillofacial Surgery. Peterson, 1993, p. 282-286.
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