Admission After Anterior Nasal Packing

Traditional management of the epistaxis patient mandated admission for patients with bilateral ribbon gauze packs, due to fears of potential airway compromise. Reductions in FRC, RV and TLC [28] and increased pCO₂ and falls of pO₂ [29] have been demonstrated in patients with bilateral ribbon gauze nasal packs.

With the advent of nasal tampons, epistaxis protocols that allow for safe discharge of specific groups of patients, with early review in the ENT clinic, have been developed and evaluated. [8,24] However, these protocols still suggest that specific groups of patients with anterior packs in place are admitted for further observation:

• Traumatic cause for the epistaxis
• Haemodynamic compromise or shock
• Previous nasal packing within the last 7 days
• Patient is taking anticoagulant medication
• Measured haemoglobin less than 10 g/dl
• Uncontrolled hypertension
• Significant co-morbid illness
• Adverse social circumstances (e.g. the patient lives alone, or more than 20 minutes away from the hospital, or has no access to telephone or transport)
• Patient’s personal preference

The use of these protocols was accompanied by a readmission or significant complication rate of between 9 and 11% and, therefore, providing comprehensive discharge advice is important.