The Cribsiders S7 Ep172: Getting Nosy About Nosebleeds: A Primer on Epistaxis
Mar 25, 2026
Dr. Jennifer Lavin, a pediatric otolaryngologist and professor focused on sinonasal disorders and patient safety. She breaks down where pediatric nosebleeds come from and correct first‑aid. Learn practical ED escalation steps, when to use absorbable hemostats or tranexamic approaches, and how to recognize rare causes like juvenile nasopharyngeal angiofibroma.
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Prefer Absorbable Hemostatic Packing For Kids
- In the ED, avoid blanket silver nitrate and try absorbable hemostatic dressings when anterior source is unclear.
- Use Surgicel or Nasopore-type packs that induce clotting and dissolve rather than removable gauze in kids.
Consider Nebulized TXA As A Practical Adjunct
- Tranexamic acid (TXA) is emerging as a reasonable adjunct though literature in epistaxis is limited.
- Nebulized TXA can be easier for squirmy kids and is used for post-tonsillectomy hemorrhage in practice.
Use Mirror Cell Or Balloon Packs For Brisk Bleeds
- Use non-absorbable mirror-cell or balloon packs for brisk anterior or suspected posterior bleeds that require physical tamponade.
- These expand in-situ and usually remain for 3–5 days; consider ENT involvement when placing them.