Nose Bleeding…evidence based practice
- 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.
- 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.
TXA 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.