Podcast 536:  Epistaxis 101

<p><strong>Contributor:  Dylan Luyten, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style="font-weight: 400;">Clear the nasal passages - have the patient, if stable, blow their nose to dislodge any clot that might be in the way</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Searching for the source of bleeding can be tough. Majority of anterior bleeding is from Kesselbach’s plexus</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Placing a clamp to provide direct pressure is a mainstay of treatment</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Application of a topical agent, which may include lidocaine epinephrine tetracaine (LET), tranexamic acid (TXA), or oxymetazoline</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Nasal packing with a nasal balloon or merocel may be necessary if bleeding persists</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Posterior epistaxis can be potentially devastating - for all practical purposes are epistaxis that does not resolve with anterior packing</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Interventional radiology can be a helpful consultant for controlling of posterior epistaxis, and may be just as or more helpful than ENT</span></li> </ul> <p> </p> <p><strong>References</strong></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Supriya M, Shakeel M, Veitch D, Ah-See K. Epistaxis: prospective evaluation of bleeding site and its impact on patient outcome.</span> <em><span style="font-weight: 400;">J Laryngol Otol</span></em><span style="font-weight: 400;">. 2010;124(7):744-749.</span></span></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Shargorodsky J, Bleier B, Holbrook E, et al. Outcomes analysis in epistaxis management: development of a therapeutic algorithm.</span> <em><span style= "font-weight: 400;">Otolaryn