🩸ST3: Epistaxis
Vignette:
You are the SpR on call from home. You receive a call from an A&E SHO who is having difficulty stopping epistaxis in a 68 year old woman who is on warfarin. How would you proceed?
😮 Opening Gambit:
Epistaxis is a potential airway and circulatory emergency so I would attend immediately.
📱 Phone advice:
Over the phone I would ensure:
- That the patient was in a place of safety such as the resuscitation bay in ED
- That they were reviewed by a senior member of the ED team
- I would ask ED to initiate:
- First aid measures,
- Administer ice to the forehead,
- Ensure normotension,
- Establish intravenous access
- Bloods: full blood count, renal function, liver function, clotting screen, CRP and group and save.
- I would ask my SHO to attend with:
- Anterior and posterior nasal packs
- Silver nitrate sticks
- Headlight and Thudicums
- Rigid endoscope
- En-route I would inform my consultant of this potential emergency