Lesson 1Anterior nasal packing: types (merocel, ribbon gauze with topical agents), insertion technique, analgesiaLooks at front nose packing types like Merocel and ribbon gauze with creams, when to use, how to put in, pain relief, and watching after.
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 to do gas tests to guide fluids and fixes.
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 nosebleed needs more than usual, spotting pack failure, blood needs, when for artery blocking, and sending 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 for bad nosebleed with airway-breathing-circulation, protecting airway, oxygen, lines, fluids, blood, watch, and calling 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 for back nose packing and balloons, how to place, check, pain control, watch, and handling issues like low oxygen or tissue death.
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 burning for bleeds, who suits, silver nitrate method, tools, no-gos for thin blood or risks, and safe steps to avoid wall damage.
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 hematologyReviews handling blood thinners in bad bleeds, fixes for warfarin, new ones, heparin, when to reverse vs stop bleed, risks talk, and team with blood or 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 admission rules for bad nosebleeds like unstable pressure or risks, watch plans, ward orders, home advice, and clinic checks to cut repeats.
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 exam for bad nosebleed, start, side, thinners, other ills, past, nose check for spot, and warnings 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 stops for nosebleed, right squeeze, position, shrink creams, numb methods for ease and view without 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
