Lesson 1Anterior nasal packing: types (merocel, ribbon gauze with topical agents), insertion technique, analgesiaLooks at kinds of front nose packing like Merocel and ribbon gauze with local medicines, when to use, how to put in, pain relief plans, and watching after placement.
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 bedside checks for heavy nosebleeds, like full blood count, clotting tests, blood type, kidney work, and when to do blood gas, showing how results guide fluids and reversal.
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 usual steps, spotting failed packing, blood needs, when for vessel blocking, and signs to send to ENT or 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, monitoringDescribes first steps to steady heavy nosebleeds using airway-breathing-circulation, with airway guard, oxygen, IV lines, fluids and blood, watching, and calling for help early.
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 to use back nose packing and balloons, step-by-step putting in, checking position, pain relief, watching, and handling issues like low oxygen, tissue death, or heart rhythm problems.
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 safetyCovers when to burn front nose areas for nosebleeds, picking right patients, silver nitrate method, tools needed, risks in thinned blood cases, and safety to avoid septum harm or airway block.
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 hematologyLooks at handling blood thinners in heavy nosebleeds, reversal for warfarin, new thinners, heparin, timing against bleeding stop, risks-benefits talk, and working with blood and heart teams.
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 admission rules for heavy nosebleeds like unstable flow or high risks, watching plans, hospital orders, going home advice, and planned 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 aimed history and exam for heavy nosebleeds, stressing start, side, thinners use, other illnesses, past bleeds, nose exam to find spot, and warning signs for other causes.
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 anesthetic techniquesExplains first local steps for nosebleeds, right nose press, patient place, tightening sprays, and numbing methods for better comfort and view 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
