Lesson 1Anterior nasal packing: types (merocel, ribbon gauze with topical agents), insertion technique, analgesiaLooks at types of front nasal packing like Merocel and ribbon gauze with creams, when to use them, how to put them in step by step, pain relief plans, and watching 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 indicationsSums up main blood tests and quick checks for bad nosebleeds, like full blood count, clotting panels, blood type, kidney function, and when to do blood gases to guide fluids 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 criteriaSpells out when ongoing nosebleeds need more than basics, spotting pack failures, blood needs, when to go 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, monitoringOutlines first resuscitation steps for severe nosebleeds using airway-breathing-circulation, with airway guard, oxygen, drips, fluids and blood, watches, and calling backup 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, how to insert step by step, check placement, 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 safetyDeals with when to burn front nosebleed spots, picking right patients, silver nitrate method, gear needed, no-gos for thinned blood or high risk, and safety to avoid septum damage or airway block.
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 bad nosebleeds, reversal for warfarin, new thinners, heparin, when to reverse vs stop bleed, risks-benefits talk, 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 bad nosebleeds like unstable vitals or big health issues, monitoring setups, ward orders, going-home tips, and clinic checks to cut repeats 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 quick history and exam for severe nosebleeds, focusing on 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 anaesthetic techniquesExplains first local steps to stop nosebleeds, right nose pinching, patient position, shrink creams, and numbing tricks for comfort and view 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
