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

Abstract 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.
PMID
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Authors

Mayor MeshTerms

Tampons, Surgical

Keywords

Epistaxis

Hemorrhage

Packing

Therapy

Journal Title the journal of laryngology and otology
Publication Year Start




PMID- 29280695
OWN - NLM
STAT- MEDLINE
DCOM- 20180102
LR  - 20180102
IS  - 1748-5460 (Electronic)
IS  - 0022-2151 (Linking)
VI  - 131
IP  - 12
DP  - 2017 Dec
TI  - Intranasal packs and haemostatic agents for the management of adult epistaxis:
      systematic review.
PG  - 1065-1092
LID - 10.1017/S0022215117002055 [doi]
AB  - 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-dissolvable packs, the re-bleed rates for Rapid Rhino and Merocel were
      similar, but were higher with bismuth iodoform paraffin paste packing. Rapid
      Rhino packs were the most tolerated non-dissolvable packs. Evidence indicates
      that 96 per cent of re-bleeding occurs within the first 4 hours after nasal pack 
      removal. Limited evidence suggests that dissolvable packs are effective and well 
      tolerated by patients. There was a lack of evidence relating to: the duration of 
      pack use, the economic effects of pack choice and the appropriate care setting
      for non-dissolvable packs. CONCLUSION: Rapid Rhino packs are the best tolerated, 
      with efficacy equivalent to nasal tampons. FloSeal is easy to use, causes less
      discomfort and may be superior to Merocel in anterior epistaxis cases. There is
      no strong evidence to support prophylactic antibiotic use.
FAU - Iqbal, I Z
AU  - Iqbal IZ
AD  - Department of Otolaryngology,Freeman Hospital,Newcastle upon Tyne,UK.
FAU - Jones, G H
AU  - Jones GH
AD  - Department of Otolaryngology,Manchester Royal Infirmary,UK.
FAU - Dawe, N
AU  - Dawe N
AD  - Department of Otolaryngology,Freeman Hospital,Newcastle upon Tyne,UK.
FAU - Mamais, C
AU  - Mamais C
AD  - Department of Otolaryngology,Aberdeen Royal Infirmary,UK.
FAU - Smith, M E
AU  - Smith ME
AD  - Department of Otolaryngology,Addenbrooke's Hospital,Cambridge,UK.
FAU - Williams, R J
AU  - Williams RJ
AD  - Institute of Naval Medicine,Gosport,UK.
FAU - Kuhn, I
AU  - Kuhn I
AD  - University of Cambridge School of Clinical Medicine,UK.
FAU - Carrie, S
AU  - Carrie S
AD  - Newcastle University,Newcastle upon Tyne,UK.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Review
PL  - England
TA  - J Laryngol Otol
JT  - The Journal of laryngology and otology
JID - 8706896
RN  - 0 (Hemostatics)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Combined Modality Therapy
MH  - Electrocoagulation
MH  - Epistaxis/*therapy
MH  - First Aid
MH  - Hemostatics/*therapeutic use
MH  - Humans
MH  - *Tampons, Surgical
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Epistaxis
OT  - Hemorrhage
OT  - Packing
OT  - Therapy
EDAT- 2017/12/28 06:00
MHDA- 2018/01/03 06:00
CRDT- 2017/12/28 06:00
PHST- 2017/12/28 06:00 [entrez]
PHST- 2017/12/28 06:00 [pubmed]
PHST- 2018/01/03 06:00 [medline]
AID - S0022215117002055 [pii]
AID - 10.1017/S0022215117002055 [doi]
PST - ppublish
SO  - J Laryngol Otol. 2017 Dec;131(12):1065-1092. doi: 10.1017/S0022215117002055.