Design
A new stepwise pathway was introduced for the management of
non-traumatic, anterior epistaxis in A&E (figure 1). This intervention
involved the collaboration between A&E and ENT teams. Dissolvable nasal
packing was introduced for epistaxis which did not terminate following
10 minutes of simple first aid. The packing used was TXA (500mg/ml)
soaked NasoPore®.
Patients were discharged if there was no further bleeding one hour after
insertion of TXA-soaked NasoPore®. Awareness of this
pathway was raised with an educational campaign to aid implementation.
Prior to this intervention, if conservative measures were ineffective,
non-dissolvable packs were inserted (typically
Rapid-Rhino®).
A retrospective audit of all epistaxis presenting to A&E was conducted
pre- and post- implementation of the TXA-soaked
NasoPore® pathway (n=245).