Anterior Epistaxis: When compression isn’t enough

25 Aug

Usually patients come back from triage with some form of compression, be it fingers, tongue-blades, clothespin… Compression should be held for at least 20-30 minutes


If still actively bleeding, first thing is to clean out the nose. Have them blow out all clots (ONCE.  Not every 5 minutes)

Take a look to make sure an anterior bleed, and where exactly that bleed is.

If compression not working, here are some options:


Afrin:  Afrin or phenylephrine is a vasoconstrictor which usually does the trick


LET or 4% Lidocaine:  the UVA ER is stocked with Epistaxis kits which have nasal cannula, cotton balls, small plastic cup. 

Put 5-10cc 4% Lidocaine into cup, Dab cotton or gauze in the lidocaine, squeeze excess and apply to bleeding site.

Alternatively, using LET (lidocaine 4%, epinephrine 0.1%, and tetracaine 0.4%)


Silver nitrate:  If site dry, can apply Chemical cautery with silver nitrate. Roll on site.epi1


Surgicel:  Surgicel is fast-acting absorbable hemostat material. Cut to fit and place over site. Absorbs in
7-10 days.


Nasal packing or Rapid Rhino: Rapid Rhino is an inflatable balloon coated with a compound that eip2acts as a platelet aggregator and also forms a lubricant upon contact with water. Different sizes available.


Extra Pearls:

  • Once bleeding stopped, make sure the patient walks, bends down, squats to make sure no re-bleeding.
  • ENT follow-up if persistent problem.
  • Admit if cannot get it under control.



Submitted by Joran Sequeira, MD.


References: Gilman, Charles. “Focus on: Treatment of Epistaxis”. June 2009. ACEP News.


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