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Front-line epistaxis management: let's not forget the basics

Published online by Cambridge University Press:  08 March 2017

E C Ho  and
J-Y Chan
E C Ho*
Affiliation:
Department of Otolaryngology, Walsall Manor Hospital, UK
J-Y Chan
Affiliation:
Department of Otolaryngology, Birmingham Heartlands Hospital, UK
*
Address for correspondence: Mr Eu Chin Ho, 59 Spiceland Road, Birmingham B31 1NL, UK. Fax: +44 (0)121 6272291 E-mail: euchinho@yahoo.co.uk
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Abstract

Objective:

We postulated that epistaxis patients frequently have their nose packed in the accident and emergency department without any reasonable prior attempt at nasal assessment and nasal cautery.

Design:

Telephone survey of 104 accident and emergency departments.

Results:

A 100 per cent response rate was achieved. In all but one of the departments surveyed, first line management was carried out by accident and emergency doctors. Seventy-four per cent of accident and emergency doctors perform nasal cautery as first line management. Within accident and emergency departments, the availability and usage of head illumination, nasal speculums, topical anaesthesia and suction was grossly suboptimal. Only one-sixth of the accident and emergency doctors surveyed had received training in the management of epistaxis, whilst 81 per cent of accident and emergency departments would admit nasally packed patients under the ENT team.

Conclusion:

Despite the majority of accident and emergency doctors claiming to attempt nasal cautery before packing, this is unlikely to be effective if performed without the correct equipment. Better training and equipment need to be provided to accident and emergency doctors in order to optimise the management of epistaxis patients. This could potentially reduce inappropriate admissions.

Keywords

EpistaxisEmergency Medical ServicesTherapyCautery

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 7 , July 2008 , pp. 696 - 699
Copyright
Copyright © JLO (1984) Limited 2008

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Footnotes

Presented at the Midlands Institute of Otorhinolaryngology 60th Anniversary Conference, 7 October 2007, Cheltenham, and the South West ENT Academic Meeting, 22 June 2007, Bath, UK.

References

1 O'Donnell, M, Robertson, G, McGarry, GW. A new bipolar diathermy probe for the outpatient management of adult acute epistaxis. Clin Otolaryngol Allied Sci 1999;24:537–41CrossRefGoogle ScholarPubMed
2 Ahmed, A, Woolford, TJ. Endoscopic bipolar diathermy in the management of epistaxis: an effective and cost-efficient treatment. Clin Otolaryngol Allied Sci 2003;28:273–5CrossRefGoogle ScholarPubMed
3 Quine, SM, Gray, RF, Rudd, M, von Blumenthal, H. Microscope and hot wire cautery management of 100 consecutive patients with acute epistaxis – a superior method to traditional packing. J Laryngol Otol 1994;108:845–8Google Scholar
4 Duvvi, S, Khattab, A, Khalil, HS, Nunez, DA. Shortfalls in epistaxis management. A nationwide survey in UK. Clin Otolaryngol 2006;31:560–1CrossRefGoogle Scholar
5 Hashmi, SM, Gopaul, SR, Prinsley, PR, Sansom, JR. Swallowed nasal pack: a rare but serious complication of the management of epistaxis. J Laryngol Otol 2004;118:372–3CrossRefGoogle Scholar
6 Jensen, PF, Kristensen, S, Juul, A, Johannessen, NW. Episodic nocturnal hypoxia and nasal packs. Clin Otolaryngol Allied Sci 1991;16:433–5CrossRefGoogle ScholarPubMed
7 Hull, HF, Mann, JM, Sands, CJ, Gregg, SH, Kaufman, PW. Toxic shock syndrome related to nasal packing. Arch Otolaryngol 1983;109:624–6CrossRefGoogle ScholarPubMed
8 Badran, K, Malik, TH, Belloso, A, Timms, MS. Randomized controlled trial comparing Merocel and RapidRhino packing in the management of anterior epistaxis. Clin Otolaryngol 2005;30:333–7CrossRefGoogle ScholarPubMed
9 Davis, SJ, McDonald, S. Covering ENT out of hours: how confident are senior house officers? J Laryngol Otol 2006;120:587–90Google Scholar
10 Evans, AS, Young, D, Adamson, R. Is the nasal tampon a suitable treatment for epistaxis in Accident & Emergency? A comparison of outcomes for ENT and A&E packed patients. J Laryngol Otol 2004;118:12–14Google Scholar
11 Van Wyk, FC, Massey, S, Worley, G, Brady, S. Do all epistaxis patients with a nasal pack need admission? A retrospective study of 116 patients managed in accident and emergency according to a peer reviewed protocol. J Laryngol Otol 2007;121:222–7Google Scholar
12 Kotecha, B, Cocks, RA, Rothera, MP. The management of epistaxis in accident and emergency departments: a survey of current practice. Arch Emerg Med 1990;7:35–41CrossRefGoogle ScholarPubMed