RED FLAGS
ED MANAGEMENT
- Patients on full dose anticoagulants (eg, warfarin or heparin infusion)
- Patients who continue to bleed despite two good attempts at nasal packing
- Trauma patients - internal anatomy may be deformed
ED MANAGEMENT
- Suction/Blow nose>apply Afrin>Direct pressure x20 minutes
- Cauterize with silver nitrate if visible, nonbleeding vessel
- If posterior bleeding or continued anterior bleeding, proceed with packing
- T&S, Coags, Hgb if on anticoagulation/hemodynamics change
- ENT consultation for posterior/refractory bleeding, IR/OMFS if unstable