Epistaxis – Definitive ED Management

This is not specifically a post related to trauma, however we wanted to share this video, as epistaxis is a very common presenting problem in the ED.

Key points to remember about traumatic epistaxis are:

  • Exercise caution inserting packing devices into patients with suspected facial or base of skull fractures. Rapid Rhinos are meant to carry a lower risk of cranial penetration than IDCs, however anecdotally we have heard of cases of Rhinos heading superiorly and passing into the brain.
  • Do not inflate an IDC balloon unless you can see or feel the tip of the catheter in the pahrynx
  • Patients with facial trauma (even relatively minor nasal trauma or un-displaced nasal fractures) can lacerate the posterior ethmoidal artery. This commonly bleeds a lot, and then stops when the vessel spasms, and then re-bleeds (often through your packing) when the spasm relaxes. This requires operative repair, so refer intermittent heavy bleeders to ENT early.

Grays514

Image source: Grays Anatomy

If you want a great way to secure an IDC that’s up someone’s nose, here’s a great diagram from Dr Rob Greig (@drrobgreig).

drrobgreig_2015-Jul-09

Click to enlarge

Update: Here’s a video Rob has made for us demonstrating this technique. Thanks Rob!

If you found that video useful, please check out our new site, EDProcedures.com, where we have a growing bank of useful procedure videos and educational material for ED doctors. You can also sign up for our ED Procedures Courses for junior doctors, registrars and specialists/GP’s.

 

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