Viscous lidocaine intranasally for epistaxis

LucidResq

LucidResq

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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.
 
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
 
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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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?
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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.
 
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. :rolleyes:
 
WannaBeFlight said:
we carry 1% Lidocaine without Epi, 1% Xylocaine without Epi
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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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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 %
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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.
 
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.
 
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.
 
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?
Click to expand...

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!
 
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.
 
Linuss said:
Flight advocating cocaine?

I guess it is Houston...
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Cocaine is definitely still used as a topical local anesthetic and vasoconstrictor.
 
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.
 
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.
Click to expand...


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 :P
 
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 :P







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