I’ve never been much of a fan of epistaxis – it’s messy, has the potential for life-threatening exsanguination – and involves fiddling around in tight spaces.
My last ‘big bleed’ was in an elderly patient, over-anticoagulated on warfarin with a posterior bleed. Not reassured by her BP of 110 (usually 150) and HR of 90 (on beta blockers), I treat these with a major degree of respect.
Using a RapidRhino can save a lot of guddling around with packing – as the video below shows (using fellow rural doc Dr Jamie Doube as test subject).
So I was intrigued to read about using tranexamic acid for topical application for epistaxis – with suggestion may be more effective than packing for anterior bleeds. I carry TXA in my prehospital pack, on the basis that a 1g load may be useful before definitive care. You can read more about TXA from the LifeInTheFastLane crew HERE.
Can;t wait to give this a go…
Meanwhile, here’s THAT video :
http://vimeo.com/56851281
Tim,
Not sure if TXA for epistaxis is ready for prime time based on this one study. I’m not sure what type of anterior packing they were doing (“pledgets coated with tetracycline ointment”) but their success rate with these was only 31%. Even with TXA, success was only 71%. I usually use the rapid rhino product or merocel depending on availability, but have also used petroleum gauze. Failure to stop bleeding with any of these methods is pretty rare in my experience, so I’m not sure if this study can be applied to my practice. It seems either the nose bleeds in this study are worse than I see, or the anterior packs used are worse. I’d still consider TXA for the bleed that does not respond to conventional therapy, but haven’t seen enough evidence yet to make it first line. Thanks for pointing out this study!
Ben