FIGURE 1 Nasal Packing for Hemorrhage Control

A. Under general or topical anesthesia, gauze impregnated with Vaseline to facilitate insertion is layered into a bleeding nasal passage to achieve hemostasis

B. Balloon devices are commercially available to provide posterior and anterior nasal packing

FIGURE 2 Steps in Performing a Lateral Parietal Craniectomy

A. The exact location and size of the skin flap vary, depending on extent of the wound but must not extend to the midline at the top of the skull

B. Skin clips are placed for hemostasis, and burr holes elevate the skull bone flap

C–D. The bone flap is removed, the dura mater is opened to expose and release an epidural hematoma, and bleeding vessels are ligated. In the absence of significant brain swelling, the skull plate is reattached once hemorrhage is controlled and other necessary procedures have been accomplished. With significant brain swelling, the dura is closed, sometime using dural substitutes, and the bone flap is not replaced at initial operation (decompressive craniotomy)

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