Earlier this year at a conference, I met a vendor from the makers of Rapid Rhino who compared the device to the Dad Bod: it’s old and not sexy like this, but it gets the job done and everyone has them (or used them) at some point in their careers. In fact, it even looks like a Dad Bod when soaked in NS and inflated. That’s an odd analogy, I thought to myself.
But if the Dad Bod fails, what’s one to do? Before you call ENT, who may not be in-house in the middle of the night, you’ll want to do everything you can to take of the problem yourself provided it’s an anterior bleed. One solution comes in the form of a medication that benefits mortality in trauma: tranexamic acid.
In 2013, a publication from the American Journal of Emergency Medicine (1) described a RCT with 216 subjects comparing TXA (cotton ball soaked with TXA) against traditional packing (cotton ball soaked with lidocaine and epinephrine) for anterior epistaxis. Bleeding was stopped in 71% in the TXA group vs 31% in the traditional packing group. Rebleeding was less (5% to 11%) and satisfaction was higher with TXA. Furthermore, a recent case report was published in which refractory bleeding caused by rivaroxaban was arrested by TXA (2).
TXA is cheap, easy to obtain (especially if you’re at a trauma site), and worth a try if nothing else has worked.
1) TXA for Epistaxis RCT (2013)
2) Case Report (2015)