Lesson 1Anterior nasal packin': types (merocel, ribbon gauze wid topical agents), insertion technique, analgesiaReview types of anterior nasal packin' materials, includin' Merocel an' ribbon gauze wid topical agents, indications an' contraindications, detailed insertion technique, analgesia an' sedation strategies, an' post-placement monitorin' an' care.
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 an' bedside tests: CBC, coagulation panel, type & screen, blood gas indicationsSummarise key laboratory an' bedside tests in severe epistaxis, includin' CBC, coagulation studies, type an' screen, renal function, an' indications fi blood gas analysis, emphasizin' how results guide resuscitation an' reversal decisions.
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 fi escalate: failure of packin', transfusion thresholds, angioembolization indications an' referral criteriaOutline when persistent epistaxis require escalation beyond standard measures, includin' recognizin' packin' failure, transfusion thresholds, indications fi endovascular therapy, an' criteria fi ENT or higher-level referral an' ICU transfer.
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, breathin', circulation, IV access, monitorin'Describe immediate resuscitation priorities in severe epistaxis usin' an airway–breathin'–circulation approach, includin' airway protection, oxygen, IV access, fluid an' blood administration, monitorin', an' early activation of support resources.
Airway assessment and protection strategiesPositioning and oxygen delivery methodsEstablishing IV access and fluid resuscitationMassive transfusion and blood product useContinuous monitoring and team communicationLesson 5Posterior packin' an' balloon devices: indications, insertion technique, potential complicationsAddress indications fi posterior nasal packin' an' balloon devices, stepwise insertion technique, confirmation of placement, analgesia an' monitorin', an' recognition an' management of complications such as hypoxia, necrosis an' dysrhythmias.
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 an' safetyCover indications fi anterior nasal cautery in epistaxis, proper patient selection, silver nitrate technique, required equipment, contraindications in anticoagulated or high-risk patients, an' safety measures fi prevent septal injury or airway compromise.
Identifying suitable anterior bleeding sitesRequired equipment and preparation stepsStepwise silver nitrate cautery techniqueContraindications and high‑risk situationsComplications, prevention and aftercareLesson 7Anticoagulation management: reversal agents fi warfarin, DOACs, heparin; timin' an' collaboration wid hematologyReview management of anticoagulation in severe epistaxis, includin' reversal strategies fi warfarin, DOACs an' heparin, timin' of reversal versus bleedin' control, risk–benefit discussions, an' coordination wid hematology an' cardiology 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, monitorin' plan, discharge instructions, an' outpatient follow-upDefine admission criteria fi severe epistaxis, includin' hemodynamic instability an' high-risk comorbidities, outline monitorin' plans, inpatient orders, discharge instructions, an' structured outpatient follow-up fi reduce recurrence an' complications.
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 an' physical exam fi epistaxis: bleedin' source, anticoagulants, comorbiditiesDetail focused history an' physical examination fi severe epistaxis, emphasizin' bleedin' onset, laterality, anticoagulant use, comorbidities, prior episodes, targeted nasal exam fi localise source, an' identification of red flags suggestin' alternative diagnoses.
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 fi control bleedin': pressure, topical vasoconstrictors, topical anesthetic techniquesExplain first-line local measures fi control epistaxis, includin' proper nasal compression technique, patient positionin', topical vasoconstrictors, an' topical anesthetic methods dat improve comfort an' visualisation while minimisin' systemic 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
