Answer
Answer
A clear view of the bleeding source is mandatory for the use of cauterization methods. Cauterize to cease unilateral septal bleeding only. Bilateral cauterization, whether chemical or electrical, increases the risk of septal perforation.
For chemical cauterization, apply a silver nitrate stick to the red dot or oozing vessel for 5-10 seconds, then roll it over the surrounding area (1 cm) for 5-10 seconds to cauterize feeding vessels. Apply antibiotic ointment over cauterized area. This provides prophylaxis against infection and serves as a topical barrier to prevent desiccation and restart of bleeding.
Electrical cauterization is typically used by an otolaryngologist in the context of endoscopic visualization.
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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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