112. Georgie Harris on Massive Epistaxis: an ENT perspective

ENT bleeding in ICU patients is the central focus, emphasizing a simplified approach due to the complexities of critical care. The high-output vessels in the head and neck, superficial anastomoses, friable mucosa, limited tamponade, and access challenges contribute to the problem. Key anatomical areas include Little's area (Kesselbach's plexus) for anterior bleeds and Woodruff's plexus for posterior bleeds, the latter causing the most significant issues. Effective tools, good lighting, clot removal, and knowledge of anatomical landmarks are crucial for managing bleeds. Topical measures like direct pressure, silver nitrate, and SurgiCell are preferred, with Rapid Rhino packs as a secondary option before surgical intervention. The importance of post-cautery care and considering anticoagulation cessation are also highlighted.