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Pediatric Nosebleeds

Matthew DeLaney, MD and Matthieu DeClerck, MD
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17:19
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Tags ENT · Pediatrics

Epistaxis is a common complaint in the pediatric population, especially among toddlers and school-aged children. Most episodes of epistaxis will resolve before the child arrives at the clinic. Persistent or recurrent bleeding requires intervention. Matt and Matt discuss some options that go beyond just simple digital compression.

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scott w., Md -

If you use gelfoam or surgicell do they just absorb over time? How long does it stay in place?

Mike W., MD -

From Matt Declerk:
Yes. They absorb over the course of approximately 2-5 days for gel foam and approximately 5-7 days for surgicel.

Mercelle H. -

You mentioned applying lido with epi on the cotton ball with the afrin. Is this injectable 1% lido with epi that you put on the cottonball? Can you use LET?

Mike W., MD -

From Matt DeClerk:
If you are looking for a bit of topical anesthetic with vasoconstriction you can use Lido 1% with Epi from the vial. Either do a bit of local injection with a TB syringe or soak a cotton pledget and place it in the nare. Alternatively you can atomize some Lido with Epi into the affected nare with an nasal atomizer (just verify your dosing so you don't give too much!). LET would work as a topical anesthetic if you needed to do something more invasive after but it takes a bit longer to work and does not provide vasoconstriction.
Hope this helps!

JOSHUA W. -

Dr. Mike,
Just wanted some clarification on your reply. If I'm not mistaken, LET contains epinephrine as well. How does Lido 1% with epi applied topically provide superior vasoconstriction than LET?

Matt -

Yes Joshua, you are correct! I misunderstood your question. LET does indeed contain Lidocaine, Epinephrine, and Tetracaine. Matt DeLaney and I dive deeper into the conversation on wether or not you can use LET in the nare (or other mucosal surfaces for that matter) in our May mailbag. Stay tuned!

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Urgent Care Rap December 2020 Written Summary 435 KB - PDF

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