Epistaxis

Management

  • Initial attempt
    • Blow to remove clots
    • Afrin to affected nares
    • Clip or direct pressure x 10-15 minutes
  • If bleeding after clip:
    • repeat initial steps with TXA soaked pledget (500 mg/5 ml)
  • If bleeding after TXA:
    • Can see source – cautery attempt
    • Can’t see source – anterior packing/balloon
  • If bleeding after anterior packing/balloon:
    • Posterior balloon
    • Reversal of coagulopoathy
    • Neuro IR and ENT consultation

Products

Nasal tampons:

  • Merocel or rapid rhino
  • Lube with antibiotic ointment

Rapid Rhino:

  • Soak in sterile water x 30 seconds
  • Blow up with air – up to 20 cc, palpate balloon to determine
  • Removal in 24-72h

Epistat

  • Insert until posterior balloon in nasopharynx
  • Posterior balloon w/ 5-10 ml of saline – then pull forward snug
  • Anterior balloon w/ 15-20 ml of saline
  • Secure w/ umbilical clamp or C-clamp

Foley Catheter

  • Size 10-14 fr
  • Lubricate and advance to posterior oropharynbx
  • Balloon with 5-10 ml of water
  • Pull anterior traction and hold w/ umbilical or c-clamp
  • Can add merocel anterior packing if hemostasis not achieved

Antibiotic PPx

  • Apparently recommended by ACEP
  • Lubricate tampon with antibiotic ointment
  • Systemic abx PPx also recommended but controversial
    • 1st line: Keflex or Augmentin x 7-10 days
    • 2nd line: Clinda 150-300 mg x 7-10 days