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Posterior Epistaxis in the Inpatient Setting

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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'.



Any advice from you seasoned veterans out there with what has worked for you?

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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.

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