HEENT emergencies

HEENT Emergencies

A great summary of HEENT emergencies (Facial and Scalp Lacerations, Mandibular Dislocations, Auricular Lacerations, Auricular Foreign Bodies, Eyelid Lacerations, Epistaxis, Nasal Bridge Fracture Reduction, Nasal Septum Haematoma, Nasal Foreign Body, Peritonsillar Abscess

 

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Tranexamic Acid

Tranexamic AcidTXA is a safe, inexpensive medication that prevents fibrin breakdown.  In traumatic bleeding, it conveys a significant mortality benefit with an impressive NNT for mortality between 7 and 67, depending on injury severity, without apparent serious safety issues.  This benefit is associated with early administration.  TXA should not be given more than three hours after injury as it may increase mortality after this timeframe.  It appears to have equal benefit in a variety of trauma practice environments.

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Cheap solutions: Topical Tranexamic Acid for Nose Bleeds and Oral Bleeds

Topical Tranexamic Acid for Epistaxis or Oral BleedsRecently, there has been a lot of buzz about the use of topical tranexamic acid for epistaxis or oral bleeds on multiple social media platforms. Everyone seems so happy that it works so well, but we thought we would look through the literature and see what the evidence for use of topical tranexamic acid (TXA) is and how best to compound it for these clinical dilemmas. We performed a PubMed, and Ovid search using the terms “topical” AND/OR “oral solution” AND/OR “intranasal” PLUS “tranexamic acid” to answer our questions at hand.

 

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Nose Bleeding…evidence based practice

  1. Gauze ribbons, nasal tampons and nasal balloon catheters all appear to be equally effective in controlling epistaxis, however, the nasal tampons and balloon catheters appear to be less time consuming and easier to insert. The Rapid Rhino© nasal balloon catheter appears to be the easiest to insert and the least painful to patients. 
  2. Most patients discharged with nasal packing should follow-up with an  ENT physician within 48-72 hours to reduce potential complications. Most patients with anterior nasal packing do not require antibiotic prophylaxis as the incidence of Toxic shock syndrome is very low.

 

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