Lesson 1Anterior nasal packing: types (merocel, ribbon gauze with topical agents), insertion technique, analgesiaLooks at front nose pack types like Merocel and ribbon gauze with creams, when to use, no-gos, step-by-step putting in, pain relief plans, and watch after in Botswana clinics.
Choosing Merocel versus ribbon gauze packsTopical vasoconstrictors and hemostatic agentsStepwise insertion technique for anterior packsAnalgesia, sedation and patient counselingPost‑placement monitoring and removal timingLesson 2Relevant laboratory and bedside tests: CBC, coagulation panel, type & screen, blood gas indicationsSums up main blood tests and quick checks for bad nosebleeds, like full blood count, clotting, blood type, kidney work, and when for gas tests, guiding fixes and thinner stops.
CBC interpretation in acute blood lossCoagulation panel and mixing study basicsType and screen, crossmatch and timingRenal and liver tests affecting hemostasisWhen blood gas analysis is indicatedLesson 3When to escalate: failure of packing, transfusion thresholds, angioembolization indications and referral criteriaSets out when ongoing nosebleeds need more than basics, spotting pack fails, blood needs, block therapy signs, and when to call ENT or shift to ICU.
Defining failure of anterior and posterior packingTransfusion thresholds in unstable epistaxisIndications for urgent ENT or ICU consultationWhen to request interventional radiology embolizationCriteria for transfer to higher level of careLesson 4Immediate resuscitation: airway protection, breathing, circulation, IV access, monitoringSpells out first fixes for bad nosebleeds with airway-breathing-circulation steps, guarding airway, oxygen, lines, fluids, blood, watch, and early team calls.
Airway assessment and protection strategiesPositioning and oxygen delivery methodsEstablishing IV access and fluid resuscitationMassive transfusion and blood product useContinuous monitoring and team communicationLesson 5Posterior packing and balloon devices: indications, insertion technique, potential complicationsCovers when for back nose packs and balloons, step puts, checks, pain watch, and spotting fixes for low oxygen, tissue death, heart rhythm issues.
Recognizing posterior epistaxis candidatesTypes of posterior packs and balloon systemsInsertion technique and placement confirmationAnalgesia, sedation and airway precautionsMonitoring and managing complicationsLesson 6Anterior nasal cautery: indications, technique (silver nitrate), contraindications and safetyDeals with front nose burn signs, picking patients, silver nitrate steps, gear, no-gos for thinners or risks, and safe ways to dodge wall harm or airway blocks.
Identifying suitable anterior bleeding sitesRequired equipment and preparation stepsStepwise silver nitrate cautery techniqueContraindications and high‑risk situationsComplications, prevention and aftercareLesson 7Anticoagulation management: reversal agents for warfarin, DOACs, heparin; timing and collaboration with haematologyReviews handling thinners in bad nosebleeds, fixes for warfarin, new pills, heparin shots, timing vs bleed stop, risk chats, and team work with blood and heart docs.
Risk stratification for holding anticoagulantsWarfarin reversal: vitamin K and PCC useDOAC reversal agents and timingHeparin and LMWH reversal strategiesConsulting hematology and cardiology teamsLesson 8Admission criteria, monitoring plan, discharge instructions, and outpatient follow-upSets admit rules for bad nosebleeds like unstable vitals and risks, watch plans, ward orders, home tips, and clinic checks to cut repeats and issues.
Indications for hospital or ICU admissionVital sign and airway monitoring protocolsInpatient orders and nursing instructionsSafe discharge criteria and home care adviceTiming and content of outpatient follow‑upLesson 9Focused history and physical exam for epistaxis: bleeding source, anticoagulants, comorbiditiesDetails quick history and checks for bad nosebleeds, stress start, side, thinners, other ills, past bleeds, nose looks to find spot, and warning other ills.
Key questions about onset, pattern and triggersDocumenting anticoagulants and antiplatelet agentsAssessing comorbidities and bleeding historyFocused nasal and oropharyngeal examinationRed flags for tumors, trauma or systemic diseaseLesson 10Local measures to control bleeding: pressure, topical vasoconstrictors, topical anaesthetic techniquesExplains first local stops for nosebleeds, right nose squeezes, positions, shrink creams, numb methods for ease and views with low body effects.
Correct external nasal pressure techniqueOptimal patient positioning and suction useSelection and dosing of topical vasoconstrictorsTopical anesthetic choices and applicationAvoiding systemic toxicity from topical agents
