QuestionSBA
QuestionChoice
As direct pressure and ice packs have not resolved the bleeding, the next step would be to insert a nasal pack to tamponade the bleeding. As a bleeding point cannot be visualised, direct cautery is not appropriate. If packing fails to stem the bleeding or the patient becomes unstable, more invasive management (e.g. arterial ligation/embolisation) may be required.
10035982
a
Anterior nasal packing
QuestionChoice
As direct pressure and ice packs have not resolved the bleeding, the next step would be to insert a nasal pack to tamponade the bleeding. If packing fails to stem the bleeding or the patient becomes unstable, more invasive management (e.g. arterial ligation/embolisation) may be required.
10035983
b
Embolisation of the sphenopalatine artery
QuestionChoice
As no bleeding point can be identified, there is currently no target to cauterise. A nasal pack should be inserted to tamponade the bleeding.
10035984
c
Silver nitrate cautery
QuestionChoice
As direct pressure and ice packs have not resolved the bleeding, the next step would be to insert a nasal pack to tamponade the bleeding. If packing fails to stem the bleeding or the patient becomes unstable, more invasive management (e.g. arterial ligation/embolisation) may be required.
10035986
e
Ligation of the anterior ethmoidal artery
QuestionChoice
This is unlikely to help as she has already applied pressure for over 30 minutes. A nasal pack should be inserted to tamponade the bleeding.
10035985
d
Apply increased pressure for 30 minutes
QuestionComment
How long do we wait for the bleeding to stop after anterior nasal packing?
59067
User
subscriber
Racoon Eyes
Concept
Chapter
2693
6176
Epistaxis
Topic
138
Ear, Nose & Throat
19600
In cases of persistent epistaxis where the bleeding point is not visible, anterior nasal packing is the appropriate management step.
A 14-year-old girl is sent to the emergency department by her GP with a continuous nosebleed. She is advised to apply pressure on the way to the hospital and an ice pack is also applied in the waiting area, but she is still bleeding 30 minutes later.

She looks well and observations are normal. She has no past medical history, and takes no regular medications.

On examination with a nasal speculum, a bleeding point cannot be confidently identified.

What is the most appropriate next step to take?
a