1. How do you differentiate an anterior from a posterior nosebleed?
2. What type of nasal packing do you prefer if direct pressure and silver nitrate cautery fail? Guaze ribbons? Nasal foam tampons (i.e., Merocel, Rhino Rocket)? Nasal balloon tampons (i.e., Rapid Rhino)?
3. How long do you tell patients to keep nasal packing in before following up with ENT? Which patients with nasal packing need antibiotics?
4. Which patients do you admit to the hospital?
I’ll go first then:
1) More likely anterior if: Younger Age, stops easily with compression, if the bleeding point is visible, minimal blood visible in oropharynx.
2) I prefer the Rapid Rhino due to ease of use
3) Overnight, brought back to ENT ward the following morning for review. I wouldn’t use prophylactic (systemic) antibiotics if I knew the pack would be removed promptly (within 48 hrs)
4) Elderly patients, on warfarin or anticoagulants, posterior bleeds and where there is significant concern regarding head injury and observation would be required.
Oli, EM Trainee, UK
1.) I attempt to by direct visualization (hopefully). Don’t mistake hematemesis for posterior nasal bled.
2.) rapid rhino ( also use a clotting powder called “Wound Seal MD,” works wonders)
4.) I usually give all keflex for 2 days.
5.) if need surgical/IR intervention. (Rare)