Otolaryngology Book

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Posterior Nasal Hemorrhage Management

Aka: Posterior Nasal Hemorrhage Management, Epistaxis Management of Posterior Bleeding
  1. See Also
    1. Epistaxis
    2. Anterior Nasal Hemorrhage Management
  2. Epidemiology: Study of 88 episodes of posterior Epistaxis
    1. Etiologies
      1. Hypertension
      2. Aspirin or Coumadin
      3. Prior history of Epistaxis
    2. Re-bleeding
      1. Associated with removal nasal pack under 48 hours
  3. General
    1. Consult with otolaryngology
    2. Posterior bleeding is much more serious than anterior
      1. Significant blood loss can result
  4. Preparation
    1. Apply topical anesthetic and Decongestant to mucosa
  5. Management: Tamponade techniques
    1. Posterior Nasal Packing
      1. Usually performed by otolaryngology
    2. Double balloon device
      1. Apply Bactroban ointment to catheter
      2. Insert device completely into nare
      3. Posterior balloon inflated with 7-10 cc saline
      4. Withdraw catheter until posterior balloon seats
        1. Balloon stops at posterior nasal cavity
      5. Anterior balloon inflated with 15-30 cc saline
      6. Apply padded umbilical clamp across catheter
        1. Prevents balloon from dislodging
      7. Leave balloons in place for 2-5 days
    3. Foley Catheter (10 to 14 french with 30 cc balloon)
      1. Apply Bactroban ointment to catheter
      2. Insert catheter into nostril
      3. Visualize catheter tip in back of throat
      4. Inflate balloon with 10 cc saline (not 30 cc!)
      5. Withdraw balloon gently until seats posteriorly
      6. Pack anterior nasal cavity
        1. See Anterior Nasal Packing
      7. Apply padded umbilical clamp across catheter
        1. Prevents balloon from dislodging
  6. Management: Persistent Bleeding despite packing
    1. Consult Otolaryngology
      1. Nasal Packing assistance
      2. Possible surgical intervention (uncommon)
    2. Consult Intervention Radiology
      1. Embolization (preferred over surgical intervention)

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