# Viscous lidocaine intranasally for epistaxis



## LucidResq (Jul 3, 2009)

Has anyone used viscous lidocaine intranasally for a simple, anterior epistaxis? 

Saw a seasoned medic use it the other day on a amusement park employee who had simply blown his nose and started bleeding. It seemed to work pretty well. 

My concern would be introducing a little intravascular lidocaine and getting some of those funky toxicity side effects... like tinnitus, tingling in the lips/face, lightheadedness. We see these symptoms of mild toxicity on a fairly regular basis with a relatively low dose of lidocaine (10-20 cc of 1%) in cervical/paracervical blocks in OB-GYN. Figured you might have some of the same with 2% lidocaine on open capillaries, especially so close to the CNS.


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## Ridryder911 (Jul 3, 2009)

Routinely use for any nasal procedure (NG, NETI), as long no PMHX of allergies. Also great for temporary pain relief for tooth aches. 

The amount of lidocaine (1-2%) topically one does not see the s/e alike injection and IV . 

R/r 911


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## ResTech (Jul 3, 2009)

How would lidocaine have any effect on controlling a nosebleed? To my knowledge lidocaine does not have any vasoconstrictive ability and is only used in nasal procedures for its analgesic/numbing effect..... which is why lidocaine is often mixed with a alpha-1 med like epinephrine or phenylephrine to vasoconstrict and control local bleeding.

Is this not correct?


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## ADKMedic (Jul 3, 2009)

ResTech said:


> How would lidocaine have any effect on controlling a nosebleed? To my knowledge lidocaine does not have any vasoconstrictive ability and is only used in nasal procedures for its analgesic/numbing effect..... which is why lidocaine is often mixed with a alpha-1 med like epinephrine or phenylephrine to vasoconstrict and control local bleeding.
> 
> Is this not correct?



This one stumped me as well.  Often lidocaine is combined with epi in its injectable form.  Perhaps there is a preparation of viscous lidocaine/epinephrine available?  That is the only way I see this as working.


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## WannaBeFlight (Jul 3, 2009)

Being from a Medical Practice we carry 1% Lidocaine without Epi, 1% Xylocaine without Epi and 2% Lidocaine with Epi, all in injectable form. Obviously you wouldnt want to use epi on a small appendage seeing it cuts the bloodsupply off.


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## Shishkabob (Jul 3, 2009)

WannaBeFlight said:


> we carry 1% Lidocaine without Epi, 1% Xylocaine without Epi


Did I miss something?  Xylocaine is a trade name of Lidocaine.


I too would like to know why it was used for epistaxis, and what made it 'work'.


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## ResTech (Jul 3, 2009)

Xylocaine is Lidocaine.


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## Shishkabob (Jul 3, 2009)

ResTech said:


> Xylocaine is Lidocaine.



Which is why I was confused as to why they have both Lido and Xylo without Epi, since it's the same drug and same %


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## daedalus (Jul 3, 2009)

Linuss said:


> Which is why I was confused as to why they have both Lido and Xylo without Epi, since it's the same drug and same %



At the medical practice I sometimes work at we have "xylocaine" vials. Same thing.

Your going to need to create some epi impregnated gauze or something if you really want to control nosebleed. I would call medical direction before you did this.


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## ResTech (Jul 3, 2009)

The majority of nosebleeds stop with simply direct pressure by pinching the nostrils together. One problem I see with both providers and lay people is they want to keep releasing the pressure every minute or so to see if the bleeding has stopped which just prolongs the bleeding and clotting process and makes it appear they have this uncontrollable nose bleed on their hands. For most nosebleeds, I will either hold or instruct the patient to hold pressure for at least 10 mins and NOT let go until that time is up to assess hemostasis.

Given the short transport times of most EMS, I would wait til ED arrival for any treatment other than direct pressure, personally.


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## Shishkabob (Jul 3, 2009)

Cold compress as well.




During EMT ride outs, had an epistaxis call.  Went there, and she had a big pot that you use to cook spaghetti on her lap.  It was atleast 1" deep with blood, and she was extremely shocky.

2nd time in 3 days it happened.  Took her back to the ED and cauterized her nose again.


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## Flight-LP (Jul 3, 2009)

ResTech said:


> How would lidocaine have any effect on controlling a nosebleed? To my knowledge lidocaine does not have any vasoconstrictive ability and is only used in nasal procedures for its analgesic/numbing effect..... which is why lidocaine is often mixed with a alpha-1 med like epinephrine or phenylephrine to vasoconstrict and control local bleeding.
> 
> Is this not correct?



You are absolutely correct, straight Lido will only provide anesthetic properties.

Direct pressure in itself usually will correct an anterior bleed. If not, a little Afrin or good 'ol "Blow" will fix it!


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## Shishkabob (Jul 3, 2009)

Flight-LP said:


> good 'ol "Blow" will fix it!





Flight advocating cocaine?

I guess it is Houston...


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## LucidResq (Jul 3, 2009)

Wonder why the medic got the idea to use it then... I asked why and she did give vasoconstriction as the reason. 

Of course I immediately thought of combined epi and lido, which we do carry in the OB-GYN. Momentarily I thought I could be rich for creating a viscous lidocaine and epinephrine combo that smells like roses, but then realized I'd be too afraid of necrosing some noses.


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## LucidResq (Jul 3, 2009)

Linuss said:


> Flight advocating cocaine?
> 
> I guess it is Houston...



Cocaine is definitely still used as a topical local anesthetic and vasoconstrictor.


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## VentMedic (Jul 3, 2009)

Any hospital that does bronchoscopies, which is most, will have liquid cocaine which is used for prep. As well, they will have epi/lido comb and neo-synephrine.  Viscous lido by itself will not stop the bleeding.


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## Flight-LP (Jul 3, 2009)

LucidResq said:


> Wonder why the medic got the idea to use it then... I asked why and she did give vasoconstriction as the reason.
> 
> Of course I immediately thought of combined epi and lido, which we do carry in the OB-GYN. Momentarily I thought I could be rich for creating a viscous lidocaine and epinephrine combo that smells like roses, but then realized I'd be too afraid of necrosing some noses.




Sounds like she may be slightly confused..............


Linuss, 4% Cocaine is used quite often by ENT's (although occasionally also used by EMT's.....lol). Not me though, I pee clean thank ya! 
















But I can get you a good deal on the south side of town if your interested


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## Shishkabob (Jul 3, 2009)

Willing to ship?  I don't feel like driving to Houston.  The whole "drug trafficking" thing won't look good on background checks.... 'medical use' or not 







PS-- Yes, I know cocaine is used, it was a joke.


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## VentMedic (Jul 3, 2009)

Contrary to popular belief, street cocaine is impure or contaminated with other substances and varies in strength.  Even in small quantities it is an irritant and may cause a serious nose bleed.


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## Shishkabob (Jul 3, 2009)

Citing personal experience, Vent?   B)


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## VentMedic (Jul 3, 2009)

Linuss said:


> Citing personal experience, Vent? B)


 
30 years of experience working EMS and EDs in South Florida.


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## Flight-LP (Jul 3, 2009)

VentMedic said:


> Contrary to popular belief, street cocaine is impure or contaminated with other substances and varies in strength.  Even in small quantities it is an irritant and may cause a serious nose bleed.



George Jung may disagree with you! He imported some pretty decent stuff back in the 70's and 80's. You remember those days, right??????????????


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## VentMedic (Jul 3, 2009)

http://www.youtube.com/watch?v=c0WgohSHoks

Yeah see like a native.


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## WannaBeFlight (Jul 3, 2009)

Linuss said:


> Did I miss something?  Xylocaine is a trade name of Lidocaine.
> 
> 
> I too would like to know why it was used for epistaxis, and what made it 'work'.



Yeah I know they are the same, but they keep them both. I dunno!


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## maxwell (Jul 5, 2009)

ResTech said:


> How would lidocaine have any effect on controlling a nosebleed? To my knowledge lidocaine does not have any vasoconstrictive ability and is only used in nasal procedures for its analgesic/numbing effect..... which is why lidocaine is often mixed with a alpha-1 med like epinephrine or phenylephrine to vasoconstrict and control local bleeding.
> 
> Is this not correct?



Completely correct.  Use Neo.  Works great: (for nosebleeds only; it 'blows' as a pressor).  Lido doesn't stop nosebleeds.  Except for analgesia, lidocaine really doesn't do anything.  Ever.  As a rule.  It doesn't terminate pVT/VF (except for a really, really, specific case) and doesn't blunt the anoxic effects of intubation on the brain for a pt c inc. ICP.  *steps off of lidocaine soap box.*  It makes nosebleeds a little bit more gooey, though, yum.  Or cocaine.  I can neither confirm nor deny using cocaine (or to make it all proper sounding "cocaine bisulfate") to stop a nosebleed before because of its immense vasoconstrictive effects h34r:.  The aforementioned impurities can be dangerous, (well yah duh, it's what makes crack different from cocaine...it's rat poison....bonus points for folks who know the generic drug name for the impurity...that makes you bleed more...but...it's been said...crack is whack...crack is cheap!).  

Oh, and never had much success with cold packs.  As long as the blood is 'round 98F, it clots just fine.


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## VentMedic (Jul 5, 2009)

maxwell said:


> Or cocaine. I can neither confirm nor deny using cocaine (or to make it all proper sounding "cocaine bisulfate") to stop a nosebleed before because of its immense vasoconstrictive effects h34r:.


 
Don't you document it or your pharmacy require you to sign for it?   It is not that big of a deal since it is used in many ENT or Pulmonary procedures involving the upper airway.


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