Episode 982: Epistaxis Management

Managing epistaxis effectively requires a systematic clinical algorithm that prioritizes visualization and topical treatment over immediate nasal packing. Initial steps involve a primary survey for hemodynamic stability, followed by having the patient clear all clots to identify the bleeding source. Applying "LET" (Lidocaine, Epinephrine, Tetracaine) or cocaine-soaked gauze for 15 minutes provides essential vasoconstriction and anesthesia, often slowing the hemorrhage enough to allow for successful silver nitrate cauterization. If these conservative measures fail, clinicians transition to anterior nasal tampons or balloon devices, reserving posterior packing and ENT consultation for refractory cases. While some practitioners prescribe prophylactic antibiotics with packing to prevent rare complications like toxic shock syndrome, the practice remains controversial. Environmental factors such as Colorado's dry climate and anatomical issues like deviated septums significantly increase the frequency of these presentations, necessitating patient education on humidification and proper follow-up care.