Lesson 1Anterior nasal packing: types (merocel, ribbon gauze with topical agents), insertion technique, analgesiaReviews front nose pack types like Merocel and ribbon gauze with local meds, when to use, no-gos, step-by-step insertion, pain relief plans, and aftercare monitoring.
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 key lab and bedside tests for bad nosebleeds, like full blood count, clotting checks, blood type, kidney function, and when to do blood gas, guiding revival and reversal calls.
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 criteriaSpells out when ongoing nosebleed needs more than basics, spotting pack fails, blood needs, vessel block therapy signs, and when to refer 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 revival steps for severe nosebleeds using airway-breathing-circulation, with airway guard, oxygen, IV lines, fluids/blood, monitoring, 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 to use back nose packs and balloons, step insertion, placement checks, pain watch, 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 safetyDetails when to burn front nosebleed spots, picking right patients, silver nitrate method, gear needed, no-gos for thin blood or high risk, and safety to avoid septum or airway harm.
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 bad nosebleeds, reversal for warfarin, new thinners, heparin, timing vs bleed control, risk chats, and teaming with blood and heart 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 big health issues, 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, comorbiditiesGives focused history and exam for bad nosebleeds, stressing start, side, thinners, other illnesses, past bleeds, nose check to find spot, 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 anesthetic techniquesExplains first local steps for nosebleeds, right nose pinch, position, shrink sprays, and numb methods for better view and comfort without 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
