Epistaxis
From EM Clerkship · 6:52
Show by Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
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)
More episodes
- Case 17 (SR) – Infant with Tachycardia
- Deep Dive R16 (IT)
- Case 16 (IT) – Fever, SOB and… Facial Droop?
- Deep Dive R15 (SR)
- Introduction
- Patient Presentations
- Chest Pain
- Airway
- Breathing
- Circulation (Shock)
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