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WHATTODO?

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1st AID

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WHERETOPINCH?

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NASALPACKING
1. Anteriornasalpacking
2. Posteriornasalpacking
Nasalpacking nasalmucosaledema,decrease
normalmucustransport sinusitis.
Prophylacticantibiotics aregenerallyhelpful
whilethepackingisinplace.
Ararebutpotentiallylethal infectious
complication,toxicshocksyndrome(TSS)

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AnteriorNasalpacking
Anteriornasalpacking:
traditionalribbongauzepack,
prefabricatedexpandablepacks
intranasalballoonsappliedtoan
identifiedorunidentifiedbleeding
site
minipack directlytothe
bleedingsite

ProcedureTechnique
Localanesthesia:
decreasingdiscomfort,
decreasetheriskofapnea,
bradycardia,andhypotension

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AnteriorNasalpacking

Newernasalpackingmaterials
expandseveraltimesin
volumewithhydration,
makingplacementeasierfor
thephysicianandpatient
hydroxylatedpolyvinylacetal
(Merocel)andpolyvinyl
alcohol(Expandacell,Rhino
Rocket)

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AnteriorNasalpacking

Thetraditionalanteriorpackofpetrolatumgauze(0.572inch)coatedwithan
antibacterialointmentisfirmlypackedinalayeredfashiontowardthe
posteriorchoanaeafterdecongestionandlocalanesthesiaplacement

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Nasalpackingposterior
Indicatedforthosepatients
failinganteriornasalpacksor
whouponevaluationhave
knownposteriorbleeding

Preoperativeprocedure:
Requirecarefulinstruction
tothepatient
Intravenousaccessand
mildsedation

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Nasalpackingposterior

Techniqueprocedure:
Theidealpackwillseatfirmlyintheposteriornasal
cavityagainsttheseptumandfloorofthenose should
notfillthenasopharynxordepressthesoftpalate
Fortheoptimumdistributionofpressureintheposterior
nasalregion aconicalshapedrolledposteriornasal
packwiththebaseorientedposteriorlyandoutofthe
nasopharynx.
Theposteriorpackisgenerallyusedinconjunctionwith
ananteriorpacktostabilizeit

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Nasalpackingposterior

Monitoringpostposteriornasalpacking:
Shouldbeadmittedandmonitoredinanappropriatehospitalsetting.
Pulseoximetryisrecommendedtofollowoxygensaturation.
Maintenanceofbodyfluidsisimportant.
Deepveinthrombosisinthebedriddenandelderlypatientisofparticular
concern
Thegauzepackingshouldbeimpregnatedwithantibioticointment,which
willdecreasethemicrobialflorapresent.
Thepackingisusuallyleftinpositionforanaverageof3to5days.
Ifpatientsfailpacking,theyarecandidatesforfurtherintervention,
determinetoundertakeadifferentinitialprocedurebasedontheclinical
presentation.

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Balloonpacks
Moreavailableandvaried
thantheFoleycatheter
balloon
Newertypes include
doubleballoons,a
compositeofballoonand
Merocel advantageof
stayinginplaceafter
balloondeflationand
removal. Adaptedfrom:Miller,A.J.EpistaxisIn:Bailey,B.J.Head&
NeckSurgeryOtolaryngology.2nded.1998

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Balloonpacks
Complications :
A potential drawback of
balloon packs
Alar or columellar
necrosis

Adapted from : Miller, A.J. Epistaxis In : Bailey, B.J. Head &

Neck Surgery-Otolaryngology. 2nd ed. 1998
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TERIMAKASIH

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