Epistaxis

• 90% anterior (Kiesselbach Plexus)

• Most likely from 1 nare

• 10% posterior (sphenopalatine artery)

• Most likely from both nares

• Methods to Stop bleeding

• Direct pressure:

• Try afrin (oxymetazoline) 

• Hold pressure over cartilaginous area of bridge for at least 20minutes

• Lean forward

• Chemically cauterize

• If bleeding stops momentarily

• Only cauterize one side of septum

• Risk of septal perforation

• Thrombogenic Foam

• Surgicel

• Bioabsorbable

• Anterior Packing (ie Rhino-rocket)

• Soak in water, insert along floor of nasal cavity

• Posterior Packing

• Temporizing until ENT arrives

• Posterior packing should be followed by anterior packing

• If no posterior packing device, can use foley

• Lubricate with topical abx

• Advanced until seen in posterior oropharynx

• Inflate balloon with 7cc saline, retract until lodged in posterior nasopharynx

• Inflate with another 5-7cc saline

• Keep packing for 72-96 hours

• TXA

• NoPAC showed no difference in anterior packing rates when comparing with/without TXA

• 500mg TXA applied to packing