Disposition

Hospital admission is rarely required for patients when good control of anterior epistaxis has been obtained. If bleeding persists after placement of an anterior pack, the possibility of inadequate packing or a posterior bleed needs to be considered. If epistaxis cannot be controlled, or is posterior in origin, emergency ENT consultation should be requested.

At the time of discharge, patients should be given these instructions:

• Do not manipulate the external nares or insert any foreign object into the nasal cavity. If there is no packing, as an exception, the patient may apply petrolatum jelly or triple-antibiotic ointment to dry mucosa. This is performed gently with a sterile cotton-tipped applicator once or twice daily for 3 to 4 days.

• Do not use aspirin or nonsteroidal anti-inflammatory agents for 3 or 4 days.

• If bleeding recurs from simple anterior epistaxis, where no packing has been inserted, home measures may be tried before returning to the emergency department. Patients may be advised to use an over-the-counter vasoconstrictor nasal spray (such as phenylephrine or oxymetazoline) and pinch their nose, with proper technique, for 10 to 15 min. If the bleeding continues, compression may be repeated twice more. If after three unsuccessful attempts, the bleeding continues, they should return to the emergency department immediately. Patients who have had an anterior pack inserted should return if bleeding occurs around the packing or if there is a sensation of blood trickling down the back of the throat. They should be advised to leave the pack in place and not attempt to remove it themselves.

• The patient should follow-up with a primary care or ENT physician in 2 to 3 days.

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