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Emergency Medicine Procedures
| Section 12. Otolaryngologic Procedures > |
Anterior Epistaxis Management Techniques
Sections: Absorbable Packing, Chemical Cauterization, Electrical Cauterization, Ribbon Gauze Packing, Expandable Nasal Sponges/Tampons, Inflatable Nasal Balloon Catheters, ENTaxis Nasal Packing.
Topics Discussed: epistaxis; epistaxis control; epistaxis, anterior.
Excerpt:
"Anterior nasal packing is required when local measures fail to
control epistaxis. This may be due in part to anterior or structural
problems in which the bleeding source cannot be identified. It may also
be due to heavy or profuse bleeding. The premise behind placing
nasal packing is that it provides mechanical pressure and tamponades
the bleeding site.10 Note that this is an uncomfortable
procedure; therefore the previously described steps for applying
topical anesthesia should be undertaken.Diffuse bleeding is frequently encountered in patients with coagulopathies
and blood dyscrasias. The trauma of inserting the nasal packing
(tampon or Vaseline gauze) can lead to more serious bleeding. A
piece of Gelfoam sponge or oxidized cellulose (Surgicel) is often
effective. These substances, coated with an antibiotic ointment
(e.g., Bacitracin) provide adequate pressure and hemostasis without
extreme trauma to the nasal mucosa. This packing does not need to
be removed and will slowly dissolve with the use of a topical saline
spray, which may be started within 24 hours of the packing being
placed...."
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