In a clinical practice guideline from the American Academy of Otolaryngology-Head and Neck Surgery Foundation, just published online in Otolaryngology-Head and Neck Surgery, recommendations are presented for the management of epistaxis.

David E. Tunkel, M.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues developed guidelines to promote best practices, reduce variations in care, and improve health outcomes for patients with epistaxis.

The authors made recommendations for various action statements. At initial contact with the epistaxis patient, clinicians should distinguish between those who do and those who do not require prompt management.

For patients in need of prompt management, active bleeding should be treated with firm sustained compression to the lower third of the nose for five minutes or longer.

The clinician should treat ongoing active bleeding with nasal packing for patients in whom bleeding precludes identification of a bleeding site despite nasal compression; resorbable packing should be used for patients with a suspected bleeding disorder or for those using anticoagulation or antiplatelet medications.

Patients who undergo nasal packing should be educated about the type, timing, and plan for removal of packing, post-procedural care, and symptoms warranting reassessment. Patients with an identified site of bleeding should be treated with an appropriate intervention.

This guideline “informs clinicians about the current level of evidence and includes areas of improvement of practice — such as providing patient instructions for nasal packing care — that were developed by the guideline panel after a review of all the literature,” Tunkel said in a statement.


REFERENCE: Tunkel et al; Clinical Practice Guideline: Epistaxis;