Applied Evidence

Epistaxis: A guide to assessment and management

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Nasal packing

Nasal packing can be performed if cautery is unsuccessful in controlling the bleed or if no bleeding point is seen on examination.2 It provides direct mechanical compression and acts as a platelet aggregator, thereby facilitating coagulation.

Anterior packing. Packs should be directed posteriorly along the floor of the nasal cavity, rather than superiorly.2 After packing, examine the patient for ongoing bleeding from the contralateral nares or posteriorly in the oropharynx using a tongue depressor. If bleeding is seen, consider packing the other side before removal of the already inserted pack to increase the tamponade pressure over the septum.4

Anterior packs are effective, easy to use, widely available, and inexpensive.8 Types of packs include traditional packing, nasal tampons, and absorbable packing materials.

The Rapid Rhino is also an option. It’s an inflatable balloon pack coated with a lubricating compound. It remains in contact with the mucosa when deflated and can be left in situ for up to 4 days (FIGURE 3). It has the same rate of control of epistaxis when compared with polyvinyl alcohol. Both patients and physicians found insertion and removal of the Rapid Rhino easier with less patient discomfort.11-13

Anatomy of the nasal cavity

Absorbable packs do not require formal removal and are useful for patients with or without coagulopathies. They can be applied topically with a syringe that conforms to the 3-dimensional structure of the nasal cavity.1 The decision regarding which product to use is based on availability, cost, and physician preference.

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