Ep 223 Epistaxis Management: A Step-Wise Approach

Epistaxis management in the emergency department requires a systematic approach prioritizing airway safety and source control over immediate, aggressive intervention. Most nosebleeds are anterior and respond to sustained, direct pressure applied to the cartilaginous portion of the nose for at least 10 minutes, often supplemented by topical vasoconstrictors and anesthetics. For refractory cases, clinicians should utilize flowable hemostatic agents or "burrito" packs made of gel foam and Surgicel to avoid the discomfort of traditional nasal packing. Posterior bleeds, though rare, necessitate rapid identification and specialized tamponade devices like epistat catheters to prevent airway contamination. While hypertension often accompanies epistaxis, it rarely causes the bleed itself and should not be treated acutely. Instead, focus on anatomical source control and patient education, including instructions to avoid nose-picking and to use proper humidification for post-procedural care.