Anterior Septum Epistaxis - Silver Nitrate Cautery

Once a patient's epistaxis has stopped or has become minimal using pressure and topical adrenaline, silver nitrate cautery may be performed. Silver nitrate can be painful so adding topical lignocaine to your adrenaline soaked cotton wool will make your patient more comfortable.

Silver nitrate can traumatise a large area of mucosa and causes crust to develop. Patients with coagulopathies who receive silver nitrate cautery have a high risk of recurrent bleeding 2-3 days later, when the crust often detaches. Therefore in these patients we tend to avoid silver nitrate to minimise mucosal trauma.

Anterior Septum Epistaxis - Bipolar Diathermy

Bipolar diathermy provides a focused, high frequency electrical current. This is both more effective and more painful than silver nitrate cautery, requiring local or general anaesthetic depending on the patient. It is useful for epistaxis not controlled with silver nitrate or packing. It is also useful in patients with coagulopathy who have epistaxis not controlled with packing.