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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