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Discussion

epistaxis

Yesterday a physician came to the med-surg floor and use silver nitrate and 4% cocaine to cauterize and pack a pt's nare to control a nose bleed. Can anyone tell me what the silver nitrate and cocaine do, how do they stop the bleeding. I was quite surprised about the cocaine. I was wondering if my pt was going to get high from cocaine, but she did not. I wanted to ask the physician these question, but did not want to look stupid. This procedure is usually done in the ER

Chris:lol2:

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cocaine is a powerful vasoconstrictor.

As for the silver nitrate...

http://en.wikipedia.org/wiki/Silver_nitrate

"Medicine

Silver nitrate has antiseptic properties. It is sometimes dropped into newborn babies' eyes at birth to prevent contraction of gonorrhoea or chlamydia from the mother. Disposal of even small quantities of silver nitrate in toilets connected to a septic tank is guaranteed to destroy the septic bacteria and necessitate pumping out and flushing and seeding with fresh bacteria. Fused silver nitrate, shaped into sticks, was traditionally called lunar caustic. It is used as a cauterizing agent."

not sure how it works, knew it was an antiseptic, so maybe someone can explain further

Asoldierswife provided good info.

Silver nitrate cauterizing sticks and then nasal packing are the typical ER treatment. Cocaine use is less common, and very expensive, but I have seen it used.

  • Columnist

here's more info. from wikipedia.

http://en.wikipedia.org/wiki/cauterization#chemical_cautery

if a person has been having frequent nose bleeds, it is most likely caused by an exposed blood vessel in their nose. even if the nose is not bleeding at the time, it is cauterized to prevent future bleeding. the different methods of cauterization include burning the affected area with acid, hot metal, lasers, or silver nitrate. people often find such a procedure painful. sometimes liquid nitrogen is used as a less painful alternative, though it is less effective. in the few countries that permit the use of cocaine for medicinal purposes, it is occasionally used topically to make this procedure less uncomfortable, cocaine being the only local anesthetic which also produces vasoconstriction, making it ideal for controlling nosebleeds

they also use electrocautery for epistaxix.

on a personal note, i have had 2 episodes this past week of prolonged epistaxis. the first episode lasted longer than 60 minutes. i was out of town at the time and was treated in the er with eletrocautery. the second time, which occurred 4 days later, i went to and ent doc and was treated with chemical cautery (silver nitrate). no cocaine on either visit. hopefully this second time did the trick. neither one was any fun.

I was just told today in lecture that they no longer use Silver Nitrate in newborns eyes. Surprised me as my twins born 18 years ago had this. I think it was actually required.

Now they use Erythromycin ointment and they say it works better with less side effects.

Are some places still using the Silver Nitrate?

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