Are prophylactic antibiotics necessary for anterior nasal packing in epistaxis? (original) (raw)
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Surgical treatment of nasal packing refractory epistaxis
Brazilian Journal of Otorhinolaryngology (Impresso), 2009
Epi staxis is the main otorhinolaryngology emergency and, in severe cases, it can lead to hemodynamic instability and be life threatening. Aim: To evaluate factors involved in epistaxis resistant to nasal packing that needed surgical treatment, as well as post-surgical results. Material and Methods: Retrospective study from January 2002 to August 2007. 40 consecutive patients that underwent surgical treatment for refractory epistaxis were analyzed. Predisposing factors, procedures performed, need of blood transfusion, and recurrence were evaluated. Results: Otorhinolaryngology post operative complications (37.5%), high blood pressure (30%), and coagulopathy (15%) were the main factors related to epistaxis. 50% of the patients (n=20) presented with hemodynamic instability and 90% of them (n=18) needed blood transfusion. Eletrocauterization of the bleeding site was enough in 35% of these patients (n=14), while in 65% (n=26) was necessary cauterization and/or arterial ligation. Five patients (12.5%) had bleeding recurrence, which needed re-operation. Conclusion: Earlier indications of surgical treatment to control severe and refractory epistaxis to conventional treatment, especially in a population with high risk such as post operative bleeding and coagulopathies, may decrease the need of blood transfusion.
Nasal Packs for Epistaxis: Predictors of Success
Clinical Otolaryngology, 2020
ObjectivesTo investigate factors affecting the haemostatic success of non‐dissolvable intranasal packs in the management of acute epistaxis presenting to the emergency department (ED).DesignProspective cohort study.SettingA nationwide prospective audit examining epistaxis management at 113 sites in the UK over a 30‐day period.ParticipantsPatients 16 years or older, presenting to the ED with acute epistaxis managed with non‐dissolvable intranasal packs.Main outcome measuresThe primary outcome was pack success, defined as successful haemostasis following nasal pack removal, not requiring further packing or surgical intervention or interventional radiology.ResultsA cohort of 969 patients presented with epistaxis to the ED, with nasal packs being inserted in 54.4% by ED staff and by ENT in a further 18.9%. Overall, nasal packs were successful in 87.5%. Longer duration packs (≥21 hours) were more successful than shorter‐duration packs (89.9% vs. 84.3%, χ2 P = .028). A patient survey supp...
Evaluation of Local Causes of Epistaxis and Its Management Outcome in a Tertiary Care Hospital
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Epistaxis is a very common problem. It may be a symptom of minor or serious ailments with underlying local or systemic causes. The objectives of this study are to evaluate various local causes of epistaxis and its management outcome. MATERIALS AND METHODS A descriptive study was conducted among 120 patients who presented with epistaxis of local causes. Individual sampling unit was selected using convenience sampling technique. Nasal pinching, anterior nasal packing and posterior nasal packing were performed in conservative management. Electrocauterisation, septal surgery, nasopharyngeal surgery and endoscopic arterial ligation were considered in surgical intervention. Descriptive statistics like proportion, mean and standard deviation were calculated. For inferential statistics, Chi-square test was performed wherever applicable. RESULTS Males were more compared to females with a male and female ratio of 1.2: 1. The number of patients were more in winter and autumn; and low during monsoon season. On rhinoscopic examination 53.33% cases had bleeding from the septum, out of which 81.25% was from anterior part and 18.75% was from posterior part of the septum. Most of the nasal trauma was due to road traffic accident. Hippocratic method was performed with a success rate of 80% to control bleeding. CONCLUSION Traumatic epistaxis was the most common local cause of epistaxis. Cold, dry and low humidity may lead to higher incidence of epistaxis in the winter season. The incidence of epistaxis was higher in young adults and middle-aged people. The anterior nasal packing had more convenient and higher control among all the conservative measures.
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Epistaxis is the most common emergency in otorhinolaryngology. The usual treatment in most cases of anterior epistaxis and almost all cases of posterior epistaxis is nasal packing followed by either cauterization, embolization or ligation. This study has been undertaken to evaluate the use of nasal endoscopic cauterization as the first line treatment both in anterior as well as posterior epistaxis. MATERIALS AND METHODS The study consisted of total 36 patients, who presented with epistaxis. All patients were first managed with nasal endoscopy and endoscopic electrocautery. Only the patients in which bleeding point could not be located by initial endoscopy were managed by insertion of nasal packing. The discomforts and minor complications in patients undergoing successful endoscopic cauterization and in the patients who were taken for nasal packing were observed along with average stay of patient in the hospital. RESULTS Out of total 36 patients, 28 patients (78%) could be successfully managed directly by endoscopic cauterization without undergoing nasal packing and the obvious discomfort associated with it. The average length of hospital stay in the patients without nasal pack was 1.39 days while for patients who were managed by nasal packing the average length of hospital stay was around 3 days. The patients who underwent nasal packing, 5 (62%) had minor complications. While in patients with endoscopic treatment as first line management, no such complications were observed. CONCLUSION Along with a good success rate, endoscopic cauterization is very effective in reducing the nasal packing related complications and the duration of stay of patient in the hospital, thus reducing the cost of treatment as well. This makes endoscopic cauterization a better first line management for both anterior as well as posterior epistaxis.
European Annals of Otorhinolaryngology, Head and Neck Diseases, 2017
ANORL-602; No. of Pages 5 2 E. Bequignon et al. / European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2016) xxx-xxx is only feasible if the bleeding site is clearly visible. When the bleeding site is not identifiable or the first measures failed, anterior packing may be performed by a non-specialist physician. Epistaxis requires subsequent nasal endoscopy performed by an ENT specialist. Patients should be informed of the measures to be taken in case of epistaxis at home, and the risks associated with the various treatments.
Updates on the Management of Epistaxis
Clinical Medicine and Therapeutics, 2019
Epistaxis (i.e., nosebleed) is a common otolaryngologic emergency; however, it is seldom life-threatening and most minor nosebleeds stop on their own or under primary care from medical staff. Nonetheless, cases of recurrent epistaxis should be checked by an otolaryngologist, and severe nosebleeds should be referred to the emergency department to avoid adverse consequences, including hypovolemic shock or death. This paper reviews current advances in our understanding of epistaxis as well as updated treatment algorithms to assist clinicians in optimizing outcomes.
An Aetiopathological Study on Epistaxis in Adults and its Management
Bengal Journal of Otolaryngology and Head Neck Surgery
IntroductionEpistaxis is a common clinical problem in ENT practice. Idiopathic aetiology is said to be the most common.Aim of studyTo find out whether idiopathic epistaxis is the most common cause of primary adulthood epistaxis and to formulate the best treatment protocolMaterials & MethodsA prospective study was conducted in a tertiary healthcare setup from August 2013 to August 2014. 100 patients of more than 16 years of age of both sexes were studied. Patients presenting with active nasal bleeding in ENT ER and OPD were included.ResultsTruly idiopathic epistaxis was encountered in 37% of the study population followed by 20% cases in association with grossly deviated septum with septal spur(s). Most of the cases were managed by resuscitation alone with or without anterior nasal packing. Conclusion: With advances in endoscopy & imaging techniques, cause of the epistaxis can most often be elicited and by sticking to a management protocol recurrence can be reduced.
Annals of Emergency Medicine, 2021
Study objective: Epistaxis is a common emergency department (ED) presentation and, if simple first aid measures fail, can lead to a need for anterior nasal packing. Tranexamic acid is an agent that contributes to blood clot stability. The aim of this study is to investigate the effectiveness of topical intranasal tranexamic acid in adult patients presenting to the ED with persistent epistaxis, and whether it reduces the need for anterior nasal packing. Methods: From May 5, 2017, to March 31, 2019, a double-blind, placebo-controlled, multicenter, 1:1, randomized controlled trial was conducted across 26 EDs in the United Kingdom. Participants with spontaneous epistaxis, persisting after simple first aid and the application of a topical vasoconstrictor, were randomly allocated to receive topical tranexamic acid or placebo. The primary outcome was the need for anterior nasal packing of any kind during the index ED attendance. Secondary outcome measures included hospital admission, need for blood transfusion, recurrent epistaxis, and any thrombotic events requiring any hospital reattendance within 1 week. Results: The study sample consisted of 496 participants with spontaneous epistaxis, persisting after simple first aid and application of a topical vasoconstrictor. In total, 211 participants (42.5%) received anterior nasal packing during the index ED attendance, including 111 of 254 (43.7%) in the tranexamic acid group versus 100 of 242 (41.3%) in the placebo group. The difference was not statistically significant (odds ratio 1.107; 95% confidence interval 0.769 to 1.594; P¼.59). Furthermore, there were no statistically significant differences between tranexamic acid and placebo for any of the secondary outcome measures. Conclusion: In patients presenting to an ED with atraumatic epistaxis that is uncontrolled with simple first aid measures, topical tranexamic acid applied in the bleeding nostril on a cotton wool dental roll is no more effective than placebo at controlling bleeding and reducing the need for anterior nasal packing. [
A Study of Role of Nasal Endoscopy in the Diagnosis and Management of Epistaxis
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND Epistaxis is one of the most common emergencies in any ENT Department, which needs utmost attention and early intervention. If proper assessment on arrival of the patient is not done, a significant morbidity and mortality can occur. MATERIALS AND METHODS All epistaxis patients were subjected to nasal endoscopy under Local or General Anaesthesia on arrival in Emergency Ward. The most useful and definitive method to find out the bleeder in epistaxis is nasal endoscopy and electrocautery. A three-year retrospective clinical study of management of epistaxis with endoscopic cauterisation was done from July 2013 to July 2016 in the Department of ENT in MGM Medical College and LSK Hospital, Kishanganj, for 180 patients. RESULTS In most of the epistaxis patients, bleeding was controlled with nasal endoscopy and cautery successfully. CONCLUSION The study was conducted to establish the fact that the best way to manage epistaxis is by doing nasal endoscopy at the first outset to find out the bleeder and cauterise. It reduces cost, hospital stay and complications of nasal pack. Findings in our study for the site of bleeder will be a guide to the surgeon for successful control of epistaxis in a tense situation of active bleeding.