Cautery in epistaxis

Used in patients with epistaxis refractory to first aid methods (1).

Prior to cautery, ask the patient to blow the nose to clear out any clots and the nasal cavity should be sprayed with local anaesthetics which should ideally include a vasoconstrictor (1).

There are two main methods

• chemical cautery with silver nitrate
  • silver nitrate stick is applied to the bleeding point with firm pressure for 5-10 seconds (2)
  • used for mild active bleeding or after active bleeding has been stopped and prominent vessels have been identified
  • avoid touching other areas like facial skin, nasal alae, or other nasal mucosae (3)
  • excess chemical is removed to avoid staining of the vestibule or upper lip (2)
• electrocautery (2)
  • done by otolaryngoiogists under local anaesthetics
  • used in severe nose bleeds not controlled by chemical cautery (1)
  • uses radiation to seal the bleeding vessels (rather than direct contact)
  • damage to the anterior nares and inferior turbinate can occur as complications (2)

The risk of iatrogenic septal perforation is minimized by cauterizing one side of the septum at a time.

The interval between cautery treatments should be four to six weeks (2)

Reference:

• 1. Schlosser RJ. Clinical practice. Epistaxis. N Engl J Med. 2009;360(8):784-9
• 2. Pope LE, Hobbs CG. Epistaxis: an update on current management. Postgrad Med J. 2005;81(955):309-14
• 3. Leong SC, Roe RJ, Karkanevatos A. No frills management of epistaxis. Emerg Med J. 2005;22(7):470-2