Intranasal packs and haemostatic agents for the management of adult epistaxis: systematic review

@article{Iqbal2017IntranasalPA,
  title={Intranasal packs and haemostatic agents for the management of adult epistaxis: systematic review},
  author={Isma Z. Iqbal and G. H. Jones and Nicholas Dawe and Constantinos Mamais and M. E. Smith and R J Williams and Isla Kuhn and Sean Carrie},
  journal={The Journal of Laryngology \&\#x0026; Otology},
  year={2017},
  volume={131},
  pages={1065 - 1092}
}
Abstract Background: The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use. Method: A systematic review of the literature was performed using standardised methodology. Results: Twenty-seven eligible articles were identified relating to non-dissolvable packs and nine to dissolvable packs. Nasal packing appears to be more effective when applied by trained professionals. For non… 
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  • Medicine
    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
  • 2020
TLDR
This guideline addresses the diagnosis, treatment, and prevention of nosebleed and discusses first-line treatments such as nasal compression, application of vasoconstrictors, nasal packing, and nasal cautery.
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TLDR
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References

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Duration of nasal packs in the management of epistaxis.
TLDR
Duration in removal of nasal packs after 12 or 24 hours made a difference in the management of epistaxis, and symptoms of headache and excessive lacrimation were significantly higher when nasal packs were removed after 24 hours.
The utility of FloSeal haemostatic agent in the management of epistaxis
Abstract Background: FloSeal, a locally applied haemostatic agent, has been shown to be effective in a variety of clinical situations. This study investigated its potential benefits in the management
The use of Merocel nasal packs in the treatment of epistaxis
TLDR
Merocel nasal packing is an effective form of first line treatment in patients with epistaxis and use of the correct insertion technique is very important but is very easy to learn and perform.
Effectiveness of chitosan‐based packing in 35 patients with recalcitrant epistaxis in the context of coagulopathy
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  • Medicine
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TLDR
This study assesses the efficacy of ChitoFlex, a chitosan-based dressing made from shellfish, wrapped around a light expandable sponge packing and placed under endoscopic guidance inside the nasal cavity, to control epistaxis in the challenging setting of drug-induced coagulopathies.
Initial assessment in the management of adult epistaxis: systematic review
TLDR
Sustained ambulatory hypertension, anticoagulant therapy and posterior bleeding may be associated with recurrent epistaxis, and should be recorded.
FloSeal hemostatic matrix in persistent epistaxis: prospective clinical trial.
TLDR
This study revealed a highly effective tool in the otolaryngologist's management of persistent epistaxis, given the ease of use, decreased morbidity to the patient, and cost-effectiveness, FloSeal hemostatic matrix could change clinical practice in managing this common condition.
Should prophylactic antibiotics be used routinely in epistaxis patients with nasal packs?
TLDR
Systemic prophylactic antibiotics are unnecessary in the majority of epistaxis patients with nasal packs and the use of topical antibiotics may be more appropriate, cheaper and as effective.
Early discharge following nasal pack removal: is it feasible?
TLDR
The need for a 24-h observation period following nasal pack removal appears not to be required, and the implementation of an early discharge policy for patients treated for epistaxis by nasal packing is therefore potentially feasible, and would result in significant cost savings.
Is the nasal tampon a suitable treatment for epistaxis in Accident & Emergency? A comparison of outcomes for ENT and A&E packed patients.
TLDR
A significantly higher number of patients packed by A&E required further treatment to control bleeding than those in the group packed by ENT and it is recommended that ENT review patients prior to packing, in order to reduce the morbidity associated with multiple treatments.
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