Therapeutic embolization in the treatment of intractable epistaxis. Arch Otolaryngol Head Neck Surg. Yau, S. An update on epistaxis. Douglas R, Wormwald P. Update on epistaxis. Merocel products. Shippert Medical Technologies Incorporated.
Med Clin North Am. Liudvikas J, Daniel M. Mangement of Epistaxis in the emergency department. Emergency Medicine Reports. Comparison of nasal tampons for the treatment of epistaxis in the emergency department: a randomized control trial. Ann Emerg Med. Reichman E. Chapter Epistaxis management. Avoiding alar necrosis with post-nasal packs. Halverson, D, Borgstrom. Chapter Epistaxis. Advanced Surgical Techniques for Rural Surgeons. Mangement paradigms for posterior epistaxis: a comparison of costs and complications.
Otolaryngol Head Neck Surg. Posterior packs and the nasopulmonary reflex. Epistaxis, medical history, and the nasopumonary reflex: what is clinically relevant? The management of epistaxis. Self-instructional package. Alexandria, Va. Risk factors for recurrent spontaneous epistaxis. Mayo Clinic Proceedings. Sarhan N, Algamal A. Relationship between epistaxis and hypertension: A cause and effect or coincidence?
J Saudi Heart Assoc. Is epistaxis associated with arterial hypertension? A systemic review of the literature. General advice Suit up! Management Other than in the above cases, the first line treatment of epistaxis is conservative. Instruct the patient to squeeze hard over Little's area with one hand, whilst putting an ice pack on to their forehead. Instruct them to remain like that for at least 20 minutes, without releasing pressure to see if the bleeding has stopped.
Simple measures to stop the bleeding first i. Leave formal nasal packing BIPP soaked ribbon gauze to ENT specialist If the patient continues to bleed, or has required packing, then they must be referred to the on-call ENT team Further management If you are successful in stopping bleeding Observe the patient for 1 hour Prescribe Naseptin cream topically to both nostrils tds for one week Vaseline used in the same way thereafter may prevent further episodes Do not be tempted to cauterise prominent vessels in Little's area, unless they are bleeding, as it does not improve outcome Tell the patient to avoid hot drinks for 24hrs.
These instructions are also found in detail below. Remove device from envelope packaging, and blue plastic tube encasing if present. Soak in sterile water for at least a FULL 30 seconds. For the patient with a nasal pack, prescribe analgesics for comfort and arrange ENT follow-up in 3 days.
The role of prophylactic systemic antibiotics in patients who have nasal packs is not well established with wide variations in practice. All patients requiring a posterior pack should be admitted because of the risk of airway obstruction and subsequent hypoxemia and dysrhythmias. Supplemental oxygen is administered once the pack is placed. Patients who have sustained significant blood loss or who have abnormal vital signs or concerning comorbidities, including coagulopathies, should be hospitalized.
Finally, those with refractory epistaxis despite the above measures are admitted for vessel ligation or selective arterial embolization. In the past several years, there has been a significant expansion in the number of options available to treat epistaxis.
Traditional strategies such as nasal packs have been supplemented by the modern technology of hemostatic agents producing less patient discomfort, improved efficacy, fewer complications, and reduced requirement for emergent ENT consultation. Gilman is an assistant professor in the division of emergency medicine at Medical University of South Carolina, Charleston. Medical Editor Dr. Robert C. Solomon is an attending emergency physician at Trinity Health System in Steubenville, Ohio, and clinical assistant professor of emergency medicine at the West Virginia School of Osteopathic Medicine.
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Gilman and Dr. Solomon have disclosed that they have no significant relationships with or financial interests in any commercial companies that pertain to this educational activity.
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