Epistaxis Management

Couple of suggestions. DO NOT INFLATE THE POSTERIOR BALLOON WITH CCS!!!! This is ridiculously uncomfortable and if you are going to cause a bradyarrhythmia it will be from this action. I once caused a systole in an elderly patient by going to ten ccs off the bat. It took about 10 minutes of aggressive cpr to get her back, and while we did stop the nosebleed with the stopping of her heart, and her husband repeatedly thanked me(prior to ROSC) for "everything I had done"...(very bizarre, it was like yeah she came in with a nosebleed and now she is dead....thanks doc). Well what I learned from this, the dreaded arrhythmia we fear with a post pack is most likely to occur with a relatively rapid inflation to the max 10cc of the post balloon. I have also found it is rarely needed. I also have changed my practice. With the elderly on coumadin or similar gushing blood from both nares....skip all the other crap and go right to a post balloon. Even if not on coumadin. The temptation is to place something less invasive, but that usually results in three different unsuccessful techniques or briefly successful with the impending repeat visit before shift end. There is nothing to fear of the posterior balloon if done right. I always premedicate with an opiate as these are uncomfortable(translation hurt like a son of a bitch initially). numb the anterior with cocaine and viscous lido 20 minutes, insert catheter, slowly inflate post balloon to about 4 cc and pull back. Inflate ant balloon to the extent needed. Document these volumes carefully. Gradually add more to the posterior balloon as needed to obtain hemostasis. observe pt on a monitor for an hour or so after insertion and inflation. If they are going to have a brady systolic rhythm it will be with the initial placement. I find patients tolerate this well. It pretty much never fails and it stops all those horrendous bleeds with your first tool...not the third. I find anterior bleeds basically stop with any of the devices, though the balloon anterior packing seems to work the best and be the most efficient.

I meant to say "10ccs!" in the initial sentence.

To echo the above comments, I would avoid placing 10ccs off the bat with the Rapid Rhino as well for the same reason. I have found you can use as little as 2-3cc with the same effect and much less uncomfortable.

Thanks for the post.

interesting comments, thanks