Emergency Medical Minute

Contributor: Meghan Hurley, MD Educational Pearls: 1. Initial Assessment Start with a physical examination: Determine if the bleed is anterior or posterior. Perform a primary survey: assess airway, breathing, and circulation (ABCs). Airway compromise = intubation immediately. If the patient is stable, have them blow out any clots, then re-examine the nares. 2. Topical Medications Anesthetics: provide local anesthesia and pain relief. Lidocaine Tetracaine Vasoconstrictors: reduce bleeding. LET (Lidocaine, Epinephrine, Tetracaine) is ideal because it provides anesthesia and vasoconstriction. Cocaine pledgets (less common). Tranexamic acid (TXA). Oxymetazoline (Afrin). Cautery (Chemical): If an anterior bleed is visualized, silver nitrate can be applied for cauterization 3. Technique Tips Use a nasal speculum. Spread up and down rather than side to side to avoid injury to the septum. Place LET-soaked gauze in the nares. Apply a nasal clamp for ~15 minutes to comp