ENT

Question 1

Discharge in epistaxis if :

Answer 1

*​if completely stable
*​bleeding ceases with simple measures and does not recur within 1-2 hours of observation
*​definitive treatment has occurred (e.g. cautery)
*​adequate social supports
*​follow up organised (GP or ENT)

Question 2

Discharge advice in epistaxis:

Answer 2

*​discharge advice
-​avoid bending straining
-​avoid nose blowing and picking
-​avoid aspirin / NSAIDS / warfarin
-​avoid low humidity environments (e.g. air conditioning)

Question 3

Admission in epistaxis if:

Answer 3

*​elderly patients
-​especially those with underlying cardiac or respiratory disease
*​patients with coagulopathy
*​patients with posterior packs
-​episodic desaturation may occur
-​especially in patients with chronic cardiorespiratory disease
-​dislodgement of the pack into the orophaynx can occur
-​rest is required to prevent re-bleeding
-​HDU or specialised ENT ward admission required
*​ICU may be required in the compromised elderly patient complicated by coagulopathy

Question 4

Complications of Nasal packing:

Answer 4

Early
*​vasovagal syncope
*​respiratory depression via nasopulmonary reflex
Later
*​displacement and airway obstruction
*​epiphoria (bleeding from the eye)
*​sinusitis
*​pressure necrosis of the alar