Epistaxis Posterior Pack

Jess Mason reviews how to place a posterior tamponade balloon for posterior epistaxis. Here we use the Epistat device, which has both an anterior and posterior balloon, to achieve tamponade of the bleed.

Kenneth D. -

Grisly, but it works. Do you send them home with that, admit or get emergent ENT consult. Also, how much lidocaine?

Greg M. -

Can you use NS instead of air? How long to you keep it in? ENT had me keep the last one in for 3 days.

Mark G. -

What atomizer do you use? That looks small and (hopefully) inexpensive.

Jess Mason -

Thanks for the great questions. I would not send someone home with a posterior pack -- too high risk for airway issues and they have already declared themselves to be a sick subset. Also (and this is KEY) posterior packs are not definitive care -- this is a bridge to either IR embolization or surgical ligation. So if you place a posterior pack this should be followed by a call to a specialist.

Regarding NS instead of air - the manufacturer actually recommends sterile water, BUT, I use air just in case it ruptures it won't pour liquid down their posterior pharynx.

The atomizer is just the intranasal mucosal atomizer device (MAD). There are probably a few brands that make it but I try to avoid calling out the specific brand unless it's unavoidable.

Greg M. -

One “trick” I learned if you use water. If you fill only one chamber (I.e. the anterior) and if you have to deflate it to remove it and it won’t come out try aspirating the other chamber. The water can shift to the other chamber and partially inflate it causing it to get stuck.

Kendall A G., M.D. -

Jess, I thought that the inflation procedure was to blow up the posterior balloon first, then pull it forward to snug it into the posterior nasopharynx, then inflate the anterior balloon. Does this order not matter?

Sean G., M.D. -

One thing I have learned was to inflate the post balloon slowly to avoid increased vagal tone. I will go with the minimum nec to achieve hemostasis.

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
Mobile Video (180p) 17.6 MB - MP4Small Video (400p) 18.0 MB - MP4Standard Video (720p) 89.2 MB - MP4