Epistaxis

Summary: <br> Don’t forget to wear protective gear. Gown up!<br> <br> <br> <br> Initial Encounter<br> <br> <br> <br> * History* Anticoagulants* Easy bleeding/bruising* Lightheadedness* Exam* Pallor* Tachycardia/Hypotension<br> <br> <br> <br> Step 1: Put on Personal Protective Equipment<br> <br> <br> <br> * Gown* Gloves* Mask* Eye Protection<br> <br> <br> <br> Step 2: Clear Nose and Visualize Bleeding<br> <br> <br> <br> * 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<br> <br> <br> <br> Step 3: Spray In Oxymetazoline (Afrin)<br> <br> <br> <br> * Hold pressure for 15 minutes after initial application<br> <br> <br> <br> Step 4: Cauterize With Silver Nitrate<br> <br> <br> <br> * Avoid bilateral cauterizations* Can cause septal perforation* Anesthetize as necessary* 4% lidocaine on gauze and leave in nose for 10 minutes prior to cauterization<br> <br> <br> <br> Step 5: Pack the Nose<br> <br> <br> <br> * Multiple commercial products available for this* The utility of antibiotic prophylaxis at this step is unclear* Patient goes home with packing in place<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Epistaxis Management <a href="https://www.youtube.com/watch?v=4EaEYx2iHqM">(EM:RAP)</a><br>