Epistaxis... what do you do?

[pinipig523]

---

Members don't see this ad.

Hey guys -

I just wanted to get an idea of what those more senior than me do for epistaxis management.

I want to see what your protocol is from initially seeing the patient to your Plan A to B to C to D. The more detail, the better.

Thanks!

 

[pinipig523]

Nobody?

OK, I'll start with my protocol.

1. Blow then pressure
2. Blow then afrin spray then pressure
3. Blow then afrin spray then either cocaine+afrin dipped cotton balls or rhino rocket + bacitracin.
4. If for some reason that fails, then rapid rhino dipped in either water or water with some afrin.

Some attendings have told me to just go straight to rhino rocket or rapid rhino and call it a day. I'm interested in what you guys are doing.

 

[southerndoc]

Afrin unless it's bleeding quickly and then I go straight to packing. I pack even if it's stopped bleeding if their INR is up from warfarin or if they're on a cocktail of anticoagulants (plavix, effient, etc) learned the hard way on quite a few patients that when you send the, out with an INR of 5 they'll come back an hour later bleeding again.

 

[pinipig523]

Speaking of warfarin...

If you have stopped the bleed, left an anterior pack in there. Their warfarin was 6 at presentation. You've given FFP and Vit K 10 po or iv... they have good PCP f/up the next day.

Are you guys comfortable sending the patient home or keep them for 23h obs?

Another question:

Rhino rocket or rapid rhino or merocel - which do you like?

 

[deleted65604]

You can muck around with these patients for hours and risk repeated ER returns. I try to minimize time in the ER. I pack them all with rapid rhino after afrin sprayed in involved nostril. If it is severe or they are on plavix or coumadin, they need packing. If it is minor, they deserve to be miserable for a couple of days as prophylaxis for future visits. If they are on oxygen, I'll give them the option of afrin and attempted cauterization without packing if it is relatively minor.

 

[pinipig523]

You can muck around with these patients for hours and risk repeated ER returns. I try to minimize time in the ER. I pack them all with rapid rhino after afrin sprayed in involved nostril. If it is severe or they are on plavix or coumadin, they need packing. If it is minor, they deserve to be miserable for a couple of days as prophylaxis for future visits. If they are on oxygen, I'll give them the option of afrin and attempted cauterization without packing if it is relatively minor.

Yes! This is what I like to hear... go straight for the anterior pack then send home after observing for 30 minutes.

 

[Rendar5]

I look in their nose with a nasal speculum (we have them available in my shop). If I can't visualize the bleed, then i'm concerned it may be more posterior. I tend to use the anterior-posterior rapid rhinos after afrin. Now if it's a basic nosebleed without anticoagulants or very high blood pressure, I'm willing to force the patient to pinch their nose nonstop for 15 minutes and I'll give an afrin spray.