From episode 169 on our Medicine Stream. With Dr Johan Schoeman.
How much do you love diagnostics for nasal disease? (Me neither.) Even if you do have a scope - it’s very hard to identify the problem area when the entire nose is filled with blood, right? Some pro tips to reduce this from medicine specialist Dr Johan Schoeman:
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Pre-scoping: Soak some swabs in a 50/50 mixture of lignocaine and a decongestant nasal spray containing oxymetazoline hydrochloride (trade name Iliadin). Shove (gently!) these soaked swabs up the nostril as deep as it will go with artery forceps, and leave them in for 5-10 mins. This will reduce bleeding significantly while you scope.
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Note - don’t use adrenaline at this stage - it will blanch the mucosa excessively, which can make interpreting pathology tricky.
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Post-scoping/ post- biopsy: Soak cotton ear buds in 1 ml of adrenaline diluted in 100ml of saline (don’t use un-diluted adrenaline) and pack as many of these into the nostril as it will hold. This will stop that torrent of blood that we hate so much and that discourages us from taking decent biopsies.
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