Answer
Answer
Anterior nasal packing is indicated for overt or suspected epistaxis after direct pressure, topical agents, or silver nitrate cauterization. It may be indicated in hematemesis or melena (either of which can be a presentation of posterior epistaxis).
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Media Gallery
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Nasal speculum.
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Nasal vascular anatomy.
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Lidocaine 2%.
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Epinephrine 1:1000.
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Epistaxis tray.
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Frazier suction tip.
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Bayonet forceps.
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Silver nitrate sticks.
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Merocel nasal packing with airway, 8 cm.
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Rapid Rhino anterior balloon tampon.
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Smaller Merocel epistaxis pack.
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Anterior nasal pressure with joined tongue depressors.
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Packing in place.
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Nasal packing with bayonet forceps and ribbon gauze.
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Patient sitting in an inappropriate, reclined position.
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Patient sitting in an appropriate, upright position.
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Patient with a history of significant left-sided epistaxis. Packing was performed in the emergency department with continued bleeding. After packing removal, small vessel arterial bleeding was noted on the anterior septum. Silver nitrate cautery is applied and dressed with dissolvable microfibrillar collagen. Video courtesy of Vijay Ramakrishnan, MD.
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