Introduction
Epistaxis occurs in approximately 60% of people worldwide at least once
in their lifetime representing the second commonest cause of
Otolaryngology emergency admissions1-5. On the other
hand, COVID-19 pandemic has spawned an unprecedented crisis overwhelming
most healthcare systems globally. Recommendations for epistaxis
management during the COVID-19 pandemic suggest the use of absorbable
nasal packing or cauterization in order to avoid hospital admissions and
visits6. However, there are cases where non-absorbable
nasal packing is needed and the patient has to be admitted, challenging
the hospital capacity, increasing the burden on the health system and
potentially exposing the patient to increased risk for COVID-19
infection.
Despite previously used protocol for the management of epistaxis in our
department we selected the “Dundee epistaxis
protocol”1 as our new “standard” in 2015. We
modified our practice and scheduled an audit, which showed a great
improvement in our practice; cautery became the main modality, nasal
packings were reduced significantly while all patients with
non-absorbable packings were admitted, and “Dundee protocol” was fully
adapted in 2016 (unpublished data). During the second wave of COVID-19
pandemic in our area, a high patient influx was noted and the high need
for hospitalization of COVID patients resulted in a dramatic reduction
of available non-COVID hospital beds in all specialties including
Otolaryngology. Thus, we re-reviewed our audit data in order to see if
we can safely reduce epistaxis admissions during the pandemic by
discharging patients with packing. Herein we present our experience with
dealing with epistaxis with nasal packing on outpatient settings with
main focus on the feasibility and safety of such management as well as
on how such protocol could relieve the pressure on the inpatient service
during the pandemic.