MikeyBoy Posted January 8, 2012 Share Posted January 8, 2012 So over the past few months, I've had a few uncontrolled epistaxis patients come my way up from the ER late at night- Often the usual, coagulopathic elderly patient or Chemo/HIV patient. I'll usually get called at like 1am because the patient has had an old packing with persistent oropharynx drainage, and there is no ENT on call. I've only done a few of these during my ER clinicals, but, I always feel uneasy because there is never really anyone up on the floors who is familiar with managing epistaxis confidently as back up. For my last patient, I just used a single balloon rhino rocket (x2 for both nares), some lidocaine (pharmacy took too long for epi), and followed generally what was listed on emedicine below, and that did okay for a few hours with much fewer clots for the patient to 'hhhock up'. http://emedicine.medscape.com/article/80545-overview Any advice from you seasoned veterans out there with what has worked for you? Link to comment Share on other sites More sharing options...
Just Steve Posted January 8, 2012 Share Posted January 8, 2012 We just had two ent lectures. Both of the otolaryngologists called nosebleeds the "bane of their existence. Both of the docs spoke highly of using foley catheters, securing the protruding end to the pt's face. Link to comment Share on other sites More sharing options...
TWR Posted January 8, 2012 Share Posted January 8, 2012 Rhino rocket, the long one. Should hold til ent consult in AM Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 9, 2012 Moderator Share Posted January 9, 2012 rapid rhino after afrin nasal spray. never had it fail, even with anticoagulated pts Link to comment Share on other sites More sharing options...
medic25 Posted January 9, 2012 Share Posted January 9, 2012 Also a fan of the Afrin/rapid rhino combination. If the patient continues to bleeding with one nostril packed, you can also pack the opposite nostril and inflate to provide some additional pressure against the septum. I've had a couple of patients fail rhino rockets, and have had success with traditional vaseline gauze packing. Take a long strip of vaseline gauze or xeroform and layer it tightly into both nasal cavities with some long bayonet forceps. It's more time-consuming, but you can really pack it in tightly. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 9, 2012 Moderator Share Posted January 9, 2012 the other issue with the rapid rhino is that sometimes you need to add a bit more air at the 10 min mark or so. I usually put in 5 cc to start then gradually add air every few min if bleeding not immediately controlled. Link to comment Share on other sites More sharing options...
MikeyBoy Posted January 9, 2012 Author Share Posted January 9, 2012 Thanks a lot everyone, really appreciate it. Link to comment Share on other sites More sharing options...
xxbowiexx Posted January 9, 2012 Share Posted January 9, 2012 excellent suggestion. Will try this method the next time. the other issue with the rapid rhino is that sometimes you need to add a bit more air at the 10 min mark or so.I usually put in 5 cc to start then gradually add air every few min if bleeding not immediately controlled. Link to comment Share on other sites More sharing options...
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