Epistaxis
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 3 April 2016
⏱️ 8 minutes
🧾️ Download transcript
Summary
Don’t forget to wear protective gear. Gown up!
Initial Encounter
* History* Anticoagulants* Easy bleeding/bruising* Lightheadedness* Exam* Pallor* Tachycardia/Hypotension
Step 1: Put on Personal Protective Equipment
* Gown* Gloves* Mask* Eye Protection
Step 2: Clear Nose and Visualize Bleeding
* Have patient blow out/remove any clot and look for source of bleed* Kiesselbachs plexus* “Anterior” epistaxis* Sphenopalatine artery* “Posterior” epistaxis* Most severe/dangerous form
Step 3: Spray In Oxymetazoline (Afrin)
* Hold pressure for 15 minutes after initial application
Step 4: Cauterize With Silver Nitrate
* Avoid bilateral cauterizations* Can cause septal perforation* Anesthetize as necessary* 4% lidocaine on gauze and leave in nose for 10 minutes prior to cauterization
Step 5: Pack the Nose
* Multiple commercial products available for this* The utility of antibiotic prophylaxis at this step is unclear* Patient goes home with packing in place
Additional Reading
* Epistaxis Management (EM:RAP)
Transcript
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| 0:00.0 | Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of |
| 0:07.1 | endless charting once you become a doctor? Do you think that doctors should be spending more |
| 0:11.9 | time with our patients and less time mindlessly writing notes? Freed AI is the product for you. It is a |
| 0:20.4 | secure, hippocompliant scribe that anybody can use. |
| 0:24.7 | Focus your energy on what matters, providing good patient care. |
| 0:29.5 | Use coupon code EM50 to save 50% the first month you try it, |
| 0:34.1 | and you can cancel at any time if you decide it's not right for you. You can learn more |
| 0:38.9 | at www.gitfreed.a.i. Hello, med students. My name is Zach Olson and today we are going to talk |
| 0:51.0 | about one of those other topics. I'm going to give you the approach to |
| 0:55.9 | nose bleeding so you can rock your emergency medicine clerkship and get top one-third in your |
| 1:02.0 | slow. Now, in this episode, there's really one thing that I want to emphasize, and that is |
| 1:07.5 | this. Protective equipment is important. It's really, really, really important. |
| 1:12.9 | It's like wearing a seatbelt. You will virtually never need it until it's too late, and then you wish |
| 1:18.2 | you had it. And I know, I know, I know. I'm the OSHA police. That's so lame. We don't have time. |
| 1:24.9 | Whatever. Listen, I get it. |
| 1:29.3 | I get lazy with this myself. |
| 1:35.8 | It's part of the whole, I'm tough, I'm fearless, I get vomited on, welcome to the pit-type culture that we love emergency medicine for. |
| 1:38.8 | But to be honest, that's dumb. |
| 1:42.3 | Don't be stupid. |
| 1:43.4 | This is something we can all improve on, |
| 1:46.0 | especially with this chief complaint, |
| 1:48.4 | because there is going to be blood everywhere, |
... |
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