Episode 3

Managing Epistaxis Alongside IR

with Dr. Sabeen Dhand

BackTable, LLC (Producer). (2020, August 4). Ep. 3 – Managing Epistaxis Alongside IR [Audio podcast]. Retrieved from https://www.backtable.com/ent

IR Sabeen Dhand and ENT Ashley Agan discuss management of Epistaxis, including how to effectively pack the nose, and when SPA ligation or arterial embolization are necessary. Dr. Dhand also describes his arterial embolization technique, including important pitfalls to avoid.

Podcast Participants

Dr. Sabeen Dhand

Dr. Sabeen Dhand

Dr. Sabeen Dhand is a practicing interventional radiologist with PIH Health in Los Angeles.

Dr. Ashley Agan

Dr. Ashley Agan

Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.

Dr. Gopi Shah

Dr. Gopi Shah

Host Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.

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Show Notes

In this episode, Dr. Sabeen Dhand, an Interventional Radiologist, joins our hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss epistaxis and the evaluation and management of different causes of epistaxis.

Dr. Agan and Dr. Dhand start the discussion by bringing up common presentations of epistaxis from both an ENT standpoint as well as IR; with the usual presentation being initially to ENT with possible referral to IR for embolization. They then continue to speak about initial treatments for epistaxis in the ED, which entails use of pressure, Afrin, and nasal packing or cauterization. If those measures aren’t sufficient, further examination in the OR may be warranted to find specific location and cause. In the case of a posterior nosebleed, usually from the sphenopalatine artery (SPA), with brisk bleeding and/or failure of ligation, SPA embolization by IR may be of use. Dr. Dhand mentions a contraindication for SPA embolization in the case of the ophthalmic artery anastomosis between the Internal Carotid Artery and External Carotid Artery due to risk of stroke and blindness. Different sources of bleeding should also be evaluated.

The discussion rounds off with the summarization of initial treatment of epistaxis. Two important considerations include proper nasal packing, pushing back into the nose and not straight up, as well as avoiding compressing nasal structures and causing necrosis and further mucosal irritation increasing bleeding risk.

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Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable ENT Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

 
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