Epistaxis is one of those things that sounds like it’s not a big deal until there’s someone gagging on their own blood, looking like an extra from Carrie. See here for an overview of managing epistaxis. There’s the nasal clip, quick cauterizing and silver nitrate, the Merocel sinus packing, Foley catheters (!), and then…the Rhinorocket.
Rhinorocket=nasal tampon extraordinaire. It is not a “Rapid Rhino” which is another kind of nasal tampon that works just as well. “One-balloon catheter” and “double-balloon catheter” refer to different types of Rhinorocket devices (reference for the image below). The double-balloon is used for posterior bleeds but some believe that it increases the risk of pressure necrosis.
The type of Rhinorocket used depends on what kind of bleeding the patient is presumed to have. It can stay in for 1-3 days (or 3-5 days depending on how bad the bleeding is) before being removed by an ENT. Regardless of what the ED tells you, patients do not have to be admitted just because they have a Rhinorocket in their nose–but they should be if there are concerns about continued bleeding or airway protection.
Some highlights of management:
- Most ENTs will also prescribe concurrent antibiotics like amoxicillin or cephalexin (or bacitracin ointment) to prevent toxic shock syndrome
- ENTs have told me you can use a whole bottle of Afrin per nare for epistaxis–not just a measly two squirts
- Can spray the nares with saline spray several times a day for cleaning purposes
- A little oozing immediately after placement is not alarming per se, but if there is ongoing bleeding into the back of the mouth that you can visualize, call ENT
- Potential complications of the Rhinorocket: otitis media or ear discomfort, pressure necrosis if not packed correctly, infection like TSS