Emergency Medical Minute Episode 982: Epistaxis Management
Nov 10, 2025
In this engaging discussion, Meghan Hurley, MD, an emergency medicine physician and clinical educator, dives deep into the essentials of managing nosebleeds. She emphasizes the importance of systematic assessment to differentiate between anterior and posterior bleeds. Meghan shares insights on effective topical agents like LET and cautery techniques to stop bleeding. Furthermore, she provides practical tips on using nasal packing devices and the role of ENT specialists for more complex cases, ensuring frontline providers are well-equipped to handle epistaxis.
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Prefer Solving Bleeds Without Packing
- Meghan Hurley, MD says she enjoys managing epistaxis and often avoids packing successfully.
- She argues many clinicians default to packing without exhausting bedside measures first.
Primary Exam Before Interventions
- Assess stability and clear clots before detailed exam to locate the bleed source.
- Use LET-soaked pledgets and a nasal clamp for ~15 minutes to anesthetize, vasoconstrict, and compress vessels.
LET First, Then Cauterize Visible Bleeds
- Use LET (lidocaine+epinephrine+tetracaine) as first-line topical for combined anesthesia and vasoconstriction.
- After 15 minutes remove pledgets, inspect, and cauterize visible anterior septal bleeds with silver nitrate.