REBEL Core Cast 123.0 – Posterior Epistaxis

Posterior epistaxis represents a dangerous and uncommon clinical pathology that requires rapid recognition and aggressive management compared to more routine anterior nosebleeds. Diagnosis is confirmed when heavy bleeding persists into the oropharynx despite proper anterior pressure or packing, often accompanied by tachycardia and potential hypotension. Initial stabilization involves IV access, cardiac monitoring, and the reversal of anticoagulation. Hemorrhage control is achieved using a commercial double-balloon posterior pack or a Foley catheter inflated with 5–10 cc of air and secured with traction. While traditional concerns regarding life-threatening brady-dysrhythmias from packing lack strong evidentiary support, these patients face significant risks of hypoxia and re-bleeding. Consequently, admission to a high-acuity setting like an ICU or step-down unit is necessary, as approximately 20% of cases require surgical intervention. Early ENT consultation remains a critical component of the care pathway.