Using the case report of a 51 year old patient with massive hemorrhage sustained from a polytrauma, the necessity of a sufficient nasal tamponade is presented. The patient was involved in a vehicular accident being a passenger. Initially she was responsive and orientated. The rescue endeavour turned out to be most difficult, with a duration of 1.5 hours. Because of the multitude of injuries the patient was intubated and sedated. Due to the nasal hemorrhage epistaxis tubes were inserted in both nostrils. With this procedure the bleeding could not be contained. Following the wound treatment and blood transfusions the epistaxis tubes were replaced by so called Ruesch tamponades (size 3) which facilitated adequate blood stasis.
The subsequent volumetric analysis of the different tubes and nasal cavity, revealed marked differences between the volume of the inflated nasal tube and the necessary volume which would develop sufficient compression. This discordance may have contributed to the massive blood loss.