Editing Nosebleed (section)

=== Nasal packing ===
If pressure and chemical cauterization cannot stop bleeding, nasal packing is the mainstay of treatment.<ref name=":2">{{Cite journal|last1=Iqbal|first1=I. Z.|last2=Jones|first2=G. H.|last3=Dawe|first3=N.|last4=Mamais|first4=C.|last5=Smith|first5=M. E.|last6=Williams|first6=R. J.|last7=Kuhn|first7=I.|last8=Carrie|first8=S.|date=December 2017|title=Intranasal packs and haemostatic agents for the management of adult epistaxis: systematic review|journal=The Journal of Laryngology & Otology|volume=131|issue=12|pages=1065–1092|doi=10.1017/S0022215117002055|pmid=29280695|s2cid=37082577|issn=0022-2151}}</ref> Nasal packing is typically categorized into anterior nasal packing and posterior nasal packing.<ref name="Kill2014">{{cite journal|last=Killick|first=N|author2=Malik, V|author3=Nirmal Kumar, B|date=Mar 2014|title=Nasal packing for epistaxis: an evidence-based review.|journal=British Journal of Hospital Medicine|volume=75|issue=3|pages=143–7|doi=10.12968/hmed.2014.75.3.143|pmid=24621629}}</ref> Nasal packing may also be categorized into dissolvable and non-dissolvable types.

Dissolvable nasal packing materials stop bleeding through use of thrombotic agents that promote blood clots, such as [[surgicel]] and [[gelfoam]].<ref name="Kell2014" /> The thrombogenic foams and gels do not require removal and dissolve after a few days. Typically, dissolvable nasal packing is first attempted; if the bleeding persists, non-dissolvable nasal packing is the next option.

Traditionally, nasal packing was accomplished by packing gauze into the nose, thereby placing pressure on the vessels in the nose and stopping the bleeding. Traditional gauze packing has been replaced with other non-dissolvable nasal packing products such as [[Polyvinyl alcohol|Merocel]] and the Rapid Rhino.<ref name=":2" /> The Merocel nasal tampon is similar to gauze packing except it is a synthetic foam polymer (made of polyvinyl alcohol and expands in the nose after application of water) that provides a less hospitable medium for bacteria.<ref name="Kell2014" /> The Rapid Rhino stops nosebleeds using a balloon catheter, made of [[Carboxymethyl cellulose|carboxymethylcellulose]], which has a cuff that is inflated by air to stop bleeding through extra pressure in the nasal cavity.<ref name=":2" /> Systematic review articles have demonstrated that the efficacy in stopping nosebleeds is similar between the Rapid Rhino and [[Merocel]] packs; however, the Rapid Rhino has been shown to have greater ease of insertion and reduced discomfort.<ref name=":2" /> Posterior nasal packing can be achieved by using a [[Foley catheter]], blowing up the balloon when it is in the back of the throat, and applying anterior traction so that the inflated balloon occludes the [[choana]]e.<ref name="Kill2014" /> Patients who receive non-dissolvable nasal packing need to return to a medical professional in 24–72 hours in order to have packing removed.<ref name="Kell2014" /><ref name="Stat2019" /> Complications of non-dissolvable nasal packing include [[abscess]]es, [[Nasal septal hematoma|septal hematomas]], [[sinusitis]], and pressure necrosis.<ref name="AFP2005" /> In rare cases [[toxic shock syndrome]] can occur with prolonged nasal packing. As a result, any patient who has non-dissolvable nasal packing should be given prophylactic antibiotic medication to be taken as long as the nasal packing remains in the nose.<ref name="AFP2005" />