Lesson 1Anterior nasal packing: types (merocel, ribbon gauze with topical agents), insertion technique, analgesiaReviews types of front nasal packing like Merocel and ribbon gauze with local agents, when to use them, how to insert properly, pain relief methods, and monitoring 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 indicationsLists important lab and bedside tests for severe nosebleeds, like full blood count, clotting studies, blood grouping, kidney function, and when to do blood gases, and how results guide resuscitation 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, angioembolisation indications and referral criteriaExplains when ongoing nosebleeds need escalation past basic steps, spotting packing failure, blood transfusion levels, when to consider vessel blocking procedures, and referral 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, monitoringOutlines urgent resuscitation for severe nosebleeds using airway-breathing-circulation steps, covering airway safety, oxygen, IV lines, fluids and blood, monitoring, 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 nasal packing and balloons, step-by-step insertion, checking position, pain control, monitoring, 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 safetyDiscusses when to use front nasal cautery for nosebleeds, choosing right patients, silver nitrate method, tools needed, risks in blood-thinned patients, and safety to avoid septum damage or airway issues.
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 blood thinners in severe nosebleeds, reversal for warfarin, new thinners, and heparin, timing reversal against bleeding control, weighing risks-benefits, and working with blood specialists.
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 severe nosebleeds like unstable vitals or high-risk conditions, monitoring plans, ward orders, discharge advice, and follow-up clinic to cut repeat bleeds and problems.
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 targeted history and exam for severe nosebleeds, focusing on bleed start, side, blood thinners, other illnesses, past bleeds, nose exam to find source, and red flags 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 anaesthetic techniquesExplains first local steps for nosebleeds, proper nose pinching, patient position, nose-tightening drops, and numbing methods for better comfort and view with low body-wide 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
