Comparison of nasal tampons for the treatment of epistaxis in the emergency department: a randomized controlled trial.

STUDY OBJECTIVE: Nasal tampons are commonly used to stop bleeding, yet their insertion is painful. We compare the pain of insertion and removal of 2 commonly used nasal tampons. METHODS: This was a prospective randomized controlled trial in 1 urban and 1 suburban emergency department (ED). Subjects were a convenience sample of adult ED patients with active epistaxis requiring insertion of a nasal tampon, regardless of coagulation status. Pretreatment of the nasal mucosa was performed using an aerosolized lidocaine-Neo-Synephrine combination. Patients were randomized to tamponade with a single Rapid Rhino or Rhino Rocket nasal tampon. The pain and ease of insertion and success of tamponade were recorded. Tampon removal was performed after 1 to 3 days, and the pain and ease of removal, as well as the presence of any bleeding, were noted. Patients rated pain of insertion and removal on a previously validated 100-mm visual analogue pain scale (100=worst pain). Physician ease of insertion and removal was recorded on a 5-point Likert scale. Continuous data are presented as means and 95% confidence intervals (CIs). RESULTS: We evaluated 40 patients evenly distributed between study groups and sites. Median patient age was 61 years (interquartile range 48 to 79 years), and 33% were female patients. Coagulopathy was present in 10 (25%) patients. Baseline characteristics were similar in both treatment groups. The mean pain of insertion of the Rapid Rhino (30 mm, 95% CI 18 to 41 mm) was significantly less than with the Rhino Rocket (48 mm, 95% CI 34 to 61 mm; mean difference 18 mm, 95% CI 1 to 35 mm). The mean pain of removal of the Rapid Rhino (11 mm, 95% CI 1 to 21 mm) was also lower than with the Rhino Rocket (23 mm, 95% CI 13 to 33 mm; mean difference 12 mm, 95% CI -1 to 25 mm). The Rapid Rhino was also easier to insert and remove and had a lower incidence of recurrent bleeding after removal than the Rhino Rocket. Rates of successful tamponade were similar in the 2 groups. CONCLUSION: The Rapid Rhino nasal tampon is less painful to insert and easier to remove than the Rhino Rocket, whereas both are similarly effective at stopping nosebleeds.

Pediatric first aid knowledge among parents.

OBJECTIVE: The American Academy of Pediatrics (AAP) has published simple guidelines for the first aid management of ill or injured children. We determined knowledge of these first aid practices in parents. METHODS: Design-Descriptive survey. PARTICIPANTS: A convenience sample of adult parents presenting to the emergency department. SURVEY INSTRUMENT: Standardized collection of demographics was performed and adults were given a multiple-choice questionnaire concerning the proper management of stings and bites, burns and scalds, eye injuries, fractures and sprains, fever, head injuries, fainting, poisoning, dental emergencies, nosebleeds, seizures, and skin wounds. OUTCOMES: Percentage of adults responding to questions appropriately based on AAP guidelines. DATA ANALYSIS: Descriptive statistics and chi2 tests. RESULTS: Six hundred fifty-four adults were surveyed. Mean age (SD) was 38.5 (13.8), 56% were female, 69% were white, 56% had at least a high school education. None of those surveyed answered all questions correctly with roughly half being familiar with 60% of the questions. Knowledge of specific guidelines ranged from 21% to 92%. Subjects especially lacked knowledge regarding the need to rapidly remove all bee stingers (only 36% aware); keep wounds moist and covered (79% felt that drying wounds was beneficial); the need to cover victims of large burns (only 43% aware); and the need to seek medical attention after tick bites (only 47% aware). Knowledge was unaffected by age, gender, and education. CONCLUSIONS: Many adults are unfamiliar with AAP first aid measures according to the AAP guidelines and most believe that wounds should be allowed to dry. Further education is required to improve knowledge of first aid practices.