Epistaxis medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
If nasal bleeding is active and nasal compression couldn't stop [[bleeding]], there are the following medical options:<ref name="TunkelAnne2020">{{cite journal|last1=Tunkel|first1=David E.|last2=Anne|first2=Samantha|last3=Payne|first3=Spencer C.|last4=Ishman|first4=Stacey L.|last5=Rosenfeld|first5=Richard M.|last6=Abramson|first6=Peter J.|last7=Alikhaani|first7=Jacqueline D.|last8=Benoit|first8=Margo McKenna|last9=Bercovitz|first9=Rachel S.|last10=Brown|first10=Michael D.|last11=Chernobilsky|first11=Boris|last12=Feldstein|first12=David A.|last13=Hackell|first13=Jesse M.|last14=Holbrook|first14=Eric H.|last15=Holdsworth|first15=Sarah M.|last16=Lin|first16=Kenneth W.|last17=Lind|first17=Meredith Merz|last18=Poetker|first18=David M.|last19=Riley|first19=Charles A.|last20=Schneider|first20=John S.|last21=Seidman|first21=Michael D.|last22=Vadlamudi|first22=Venu|last23=Valdez|first23=Tulio A.|last24=Nnacheta|first24=Lorraine C.|last25=Monjur|first25=Taskin M.|title=Clinical Practice Guideline: Nosebleed (Epistaxis)|journal=Otolaryngology–Head and Neck Surgery|volume=162|issue=1_suppl|year=2020|pages=S1–S38|issn=0194-5998|doi=10.1177/0194599819890327}}</ref> <ref name="KremplNoorily2016">{{cite journal|last1=Krempl|first1=Greg A.|last2=Noorily|first2=Allen D.|title=Use of Oxymetazoline in the Management of Epistaxis|journal=Annals of Otology, Rhinology & Laryngology|volume=104|issue=9|year=2016|pages=704–706|issn=0003-4894|doi=10.1177/000348949510400906}}</ref> <ref name="MontastrucMontastruc2014">{{cite journal|last1=Montastruc|first1=François|last2=Montastruc|first2=Guillaume|last3=Taudou|first3=Marie-Josée|last4=Olivier-Abbal|first4=Pascale|last5=Montastruc|first5=Jean-Louis|last6=Bondon-Guitton|first6=Emmanuelle|title=Acute Coronary Syndrome After Nasal Spray of Oxymetazoline|journal=Chest|volume=146|issue=6|year=2014|pages=e214–e215|issn=00123692|doi=10.1378/chest.14-1873}}</ref> <ref name="KrulewitzFix2019">{{cite journal|last1=Krulewitz|first1=Neil Alexander|last2=Fix|first2=Megan Leigh|title=Epistaxis|journal=Emergency Medicine Clinics of North America|volume=37|issue=1|year=2019|pages=29–39|issn=07338627|doi=10.1016/j.emc.2018.09.005}}</ref> <ref name="DouglasWormald2007">{{cite journal|last1=Douglas|first1=Richard|last2=Wormald|first2=Peter-John|title=Update on epistaxis|journal=Current Opinion in Otolaryngology & Head and Neck Surgery|volume=15|issue=3|year=2007|pages=180–183|issn=1068-9508|doi=10.1097/MOO.0b013e32814b06ed}}</ref> | |||
* General management of patients is important. Stabilizing the patient and treating the specific cause is the basis of management. | * <br />General management of patients is important. Stabilizing the patient and treating the specific cause is the basis of management. | ||
*<br />At first [[Airway]] , [[breathing]] and [[circulation]] should be evaluated. | |||
'''Medical Therapy:''' | |||
*'''[[Vasoconstrictors]]''' (Use with caution in children and patients with [[glaucoma]], [[Hypertension|HTN]], [[peripheral vasoconstriction]], [[Cardiac disease|cardiac diseases]] and [[cerebrovascular]] problems): | |||
**Preferred regimen (1): [[Oxymetazoline]] 0.05% [[intranasal]] [[spray]]. In children <6 years just with [[physicians]] suggestion. | |||
**Alternative regimen (1): [[Phenylephrine]] 0.25% [[intranasal spray]]. In children ≥2 years Phenylephrine 0.125% nasal solution can be used. | |||
**Alternative regimen (2): [[Epinephrine]] 1:100,000 with [[Lidocaine]] 1% (Topical ). | |||
* | *'''[[Antifibrinolytic]]''': | ||
**Preferred regimen (1): [[Tranexamic acid]] ([[Tranexamic acid|TXA]]) (Topical ).<br /> | |||
*'''[[Chemical]] [[cauterization]]''' ( At first [[anesthesia]] [[bleeding]] site and limit nasal [[cautery]] to site''':''' | |||
**Preferred regimen (1): [[Silver nitrate]] 25%-75% | |||
**Alternative regimen (1): [[Chromic acid]] | |||
**Alternative regimen (2): [[Trichloroacetic acid]] | |||
*Some [[Medicine|medicines]] are used to prevent [[epistaxis]]: | |||
**'''[[Emollient]] [[Cream (pharmaceutical)|creams]] :''' Continues using of topical [[emollient]] [[Cream (pharmaceutical)|creams]] is useful to prevent [[epistaxis]]. | |||
**'''[[Ointment|Ointments]] :''' Continues using of topical [[Ointment|ointments]] is useful to prevent [[epistaxis]] | |||
* Some [[Medicine|medicines]] are used to prevent [[epistaxis]]: | |||
** '''[[Emollient]] [[Cream (pharmaceutical)|creams]] :''' Continues using of topical [[emollient]] [[Cream (pharmaceutical)|creams]] is useful to prevent [[epistaxis]]. | |||
** '''[[Ointment|Ointments]] :''' Continues using of topical [[Ointment|ointments]] is useful to prevent [[epistaxis]] | |||
==References== | ==References== | ||
Revision as of 20:30, 27 October 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief:Amir Behzad Bagheri, M.D.
Overview
Most of the time no action is needed to stop epistaxis. In active bleeding nasal compression is the first line to stop bleeding. If bleeding continues there are other options like cautery and some vasoconstrictive agents like oxymetazoline or phenylephrine to control bleeding.
Medical Therapy
If nasal bleeding is active and nasal compression couldn't stop bleeding, there are the following medical options:[1] [2] [3] [4] [5]
General management of patients is important. Stabilizing the patient and treating the specific cause is the basis of management.
At first Airway , breathing and circulation should be evaluated.
Medical Therapy:
- Vasoconstrictors (Use with caution in children and patients with glaucoma, HTN, peripheral vasoconstriction, cardiac diseases and cerebrovascular problems):
- Preferred regimen (1): Oxymetazoline 0.05% intranasal spray. In children <6 years just with physicians suggestion.
- Alternative regimen (1): Phenylephrine 0.25% intranasal spray. In children ≥2 years Phenylephrine 0.125% nasal solution can be used.
- Alternative regimen (2): Epinephrine 1:100,000 with Lidocaine 1% (Topical ).
- Antifibrinolytic:
- Preferred regimen (1): Tranexamic acid (TXA) (Topical ).
- Preferred regimen (1): Tranexamic acid (TXA) (Topical ).
- Chemical cauterization ( At first anesthesia bleeding site and limit nasal cautery to site:
- Preferred regimen (1): Silver nitrate 25%-75%
- Alternative regimen (1): Chromic acid
- Alternative regimen (2): Trichloroacetic acid
References
- ↑ Tunkel, David E.; Anne, Samantha; Payne, Spencer C.; Ishman, Stacey L.; Rosenfeld, Richard M.; Abramson, Peter J.; Alikhaani, Jacqueline D.; Benoit, Margo McKenna; Bercovitz, Rachel S.; Brown, Michael D.; Chernobilsky, Boris; Feldstein, David A.; Hackell, Jesse M.; Holbrook, Eric H.; Holdsworth, Sarah M.; Lin, Kenneth W.; Lind, Meredith Merz; Poetker, David M.; Riley, Charles A.; Schneider, John S.; Seidman, Michael D.; Vadlamudi, Venu; Valdez, Tulio A.; Nnacheta, Lorraine C.; Monjur, Taskin M. (2020). "Clinical Practice Guideline: Nosebleed (Epistaxis)". Otolaryngology–Head and Neck Surgery. 162 (1_suppl): S1–S38. doi:10.1177/0194599819890327. ISSN 0194-5998.
- ↑ Krempl, Greg A.; Noorily, Allen D. (2016). "Use of Oxymetazoline in the Management of Epistaxis". Annals of Otology, Rhinology & Laryngology. 104 (9): 704–706. doi:10.1177/000348949510400906. ISSN 0003-4894.
- ↑ Montastruc, François; Montastruc, Guillaume; Taudou, Marie-Josée; Olivier-Abbal, Pascale; Montastruc, Jean-Louis; Bondon-Guitton, Emmanuelle (2014). "Acute Coronary Syndrome After Nasal Spray of Oxymetazoline". Chest. 146 (6): e214–e215. doi:10.1378/chest.14-1873. ISSN 0012-3692.
- ↑ Krulewitz, Neil Alexander; Fix, Megan Leigh (2019). "Epistaxis". Emergency Medicine Clinics of North America. 37 (1): 29–39. doi:10.1016/j.emc.2018.09.005. ISSN 0733-8627.
- ↑ Douglas, Richard; Wormald, Peter-John (2007). "Update on epistaxis". Current Opinion in Otolaryngology & Head and Neck Surgery. 15 (3): 180–183. doi:10.1097/MOO.0b013e32814b06ed. ISSN 1068-9508.