Treatment

The treatment of anterior epistaxis includes direct pressure, vasoconstrictive agents, nasal packing, and cautery. Despite a frequently elevated blood pressure in the setting of acute epistaxis, initial efforts at stabilization should focus on direct control of hemorrhage. Once the bleeding has been stopped and patient anxiety regarding exsanguination resolved, elevated blood pressure usually spontaneously resolves. Persistent or extremely high elevations of blood pressure can then be addressed.

Most episodes of anterior epistaxis can be managed by direct pressure to the nose. This is achieved by compressing the elastic areas of the nose between the thumb and middle phalanx of the index finger. Pressure must be continuously maintained for 10 to 15 min, and confirmed with a clock, as patients frequently underestimate the amount of time that has elapsed. Release of pressure to see if the bleeding has stopped will not allow adequate clot formation and may result in continued bleeding.

Vasoconstrictive agents may be used in conjunction with all other treatment modalities. T.a.b!e...,2,3.3.-.2, lists common vasoconstrictive agents. These compounds can be instilled into the nasal cavity by a spray bottle, an atomizer, or cotton swab. If the area of bleeding can be visualized, cotton swabs or pledgets are preferred. This provides excellent contact with the mucosa and can provide direct pressure to the site.

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Anxiety and Depression 101

Anxiety and Depression 101

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