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. 
  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.

Stopping Nose Bleeding With Tranexamic Acid

A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial.

Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M.

Am J Emerg Med. 2013 Sep;31(9):1389-92.

A 15-cm piece of cotton pledget soaked in injectable form of tranexamic acid (500 mg in 5 mL) is inserted in the nostril of the bleeding side. It is removed after bleeding arrest is determined by examining the blood-soaked pledgets and the oropharynx (approx. 10 minutes). Works better than adrenaline packs.