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).