Lesson 1Relevant laboratory and bedside tests: CBC, coagulation panel, type & screen, blood gas indicationsSummarizes key laboratory and bedside tests in severe epistaxis, including CBC, coagulation studies, type and screen, renal function, and indications for blood gas analysis, emphasizing how results guide resuscitation and 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 2Anterior nasal packing: types (merocel, ribbon gauze with topical agents), insertion technique, analgesiaReviews types of anterior nasal packing materials, including Merocel and ribbon gauze with topical agents, indications and contraindications, detailed insertion technique, analgesia and sedation strategies, and post‑placement monitoring and 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 3When to escalate: failure of packing, transfusion thresholds, angioembolization indications and referral criteriaOutlines when persistent epistaxis requires escalation beyond standard measures, including recognizing packing failure, transfusion thresholds, indications for endovascular therapy, and criteria for ENT or higher‑level referral and 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, breathing, circulation, IV access, monitoringDescribes immediate resuscitation priorities in severe epistaxis using an airway‑breathing‑circulation approach, including airway protection, oxygen, IV access, fluid and blood administration, monitoring, and 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 packing and balloon devices: indications, insertion technique, potential complicationsAddresses indications for posterior nasal packing and balloon devices, stepwise insertion technique, confirmation of placement, analgesia and monitoring, and recognition and management of complications such as hypoxia, necrosis and 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 and safetyCovers indications for anterior nasal cautery in epistaxis, proper patient selection, silver nitrate technique, required equipment, contraindications in anticoagulated or high‑risk patients, and safety measures to 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 for warfarin, DOACs, heparin; timing and collaboration with hematologyReviews management of anticoagulation in severe epistaxis, including reversal strategies for warfarin, DOACs and heparin, timing of reversal versus bleeding control, risk–benefit discussions, and coordination with hematology and 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 8Focused history and physical exam for epistaxis: bleeding source, anticoagulants, comorbiditiesDetails focused history and physical examination for severe epistaxis, emphasizing bleeding onset, laterality, anticoagulant use, comorbidities, prior episodes, targeted nasal exam to localize source, and identification of red flags suggesting 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 9Admission criteria, monitoring plan, discharge instructions, and outpatient follow-upDefines admission criteria for severe epistaxis, including hemodynamic instability and high‑risk comorbidities, outlines monitoring plans, inpatient orders, discharge instructions, and structured outpatient follow‑up to reduce recurrence and 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 10Local measures to control bleeding: pressure, topical vasoconstrictors, topical anesthetic techniquesExplains first‑line local measures to control epistaxis, including proper nasal compression technique, patient positioning, topical vasoconstrictors, and topical anesthetic methods that improve comfort and visualization while minimizing 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
