Epistaxis

Don’t forget to wear protective gear. Gown up!











Initial Encounter











* History* Anticoagulants* Easy bleeding/bruising* Lightheadedness* Exam* Pallor* Tachycardia/Hypotension











Step 1: Put on Personal Protective Equipment











* Gown* Gloves* Mask* Eye Protection











Step 2: Clear Nose and Visualize Bleeding











* Have patient blow out/remove any clot and look for source of bleed* Kiesselbachs plexus* “Anterior” epistaxis* Sphenopalatine artery* “Posterior” epistaxis* Most severe/dangerous form











Step 3: Spray In Oxymetazoline (Afrin)











* Hold pressure for 15 minutes after initial application











Step 4: Cauterize With Silver Nitrate











* Avoid bilateral cauterizations* Can cause septal perforation* Anesthetize as necessary* 4% lidocaine on gauze and leave in nose for 10 minutes prior to cauterization











Step 5: Pack the Nose











* Multiple commercial products available for this* The utility of antibiotic prophylaxis at this step is unclear* Patient goes home with packing in place











Additional Reading











* Epistaxis Management (EM:RAP)