ear, nose, and throat disorders
How To Treat Anterior Epistaxis With Cautery
Step by Step Description of Treating Anterior Epistaxis With Cautery
Have the patient gently blow the nose to remove clots, or suction the nasal passageway carefully. Insert a nasal speculum with your index finger resting against the patient's nose and the handle parallel to the floor (so the blades open vertically). Slowly open the speculum and examine the nose using a bright headlamp or head mirror, leaving one hand free to manipulate suction or an instrument. Use a Frazier-tip suction catheter to remove any blood and clots obscuring the view. Look for blood flowing from the anterior septum in the area of Kiesselbach's plexus, and look for blood flowing from the back of the nose. Apply a topical vasoconstrictor/anesthetic mixture: Place about 3 mL of 4%cocainesolution or 4%lidocainewithoxymetazolinein a small medicine cup and soak 2 or 3 cotton pledgets with the solution and insert them into the nose, stacked vertically (or spray in a topical vasoconstrictor such asoxymetazolineand place pledgets containing only topical anesthetic). Leave the topical drugs in place for 10 to 15 minutes to stop or reduce the bleeding, provide anesthesia, and reduce mucosal swelling. Usesilver nitratesticks to cauterize the site only if vasoconstriction has stopped the bleeding and the bleeding site is clearly visible. Place the tip of thesilver nitratestick against the site and roll the tip over the bleeding site for 4 to 5 seconds until an eschar forms. This will turn the mucosa a grayish color. Wipe or suction away any excesssilver nitrateto avoid any further cautery at this site or other sites in the nose. Patients often sneeze aftersilver nitratecautery, which may restart bleeding (and splatter the operator with blood), necessitating repeat cautery. If using electrocautery, place the tip of the instrument on the area of bleeding mucosa and apply coagulation current for a few seconds until charred mucosa is visible. If using thermal cautery, place the heated tip of the device on the area of bleeding for several seconds until the mucosa is charred. Protracted duration of cautery, application of cautery over a wide area, or bilateral use of cautery on the nasal septum can result in tissue injury including septal necrosis with resultant perforation. Other risks include infection and scarring. If cautery has not stopped the bleeding after 2 attempts, another technique, such as a How To Treat Anterior Epistaxis With Nasal Packing , should be used. After hemostasis is successful, apply antibiotic ointment (such asbacitracin) to the cauterized area. 