Page 128 - 2022 Ranger Medic Handbook

Epistaxis
DEFINITION: Anterior or Posterior Nosebleed
S/Sx: Nosebleed, often previous history of nosebleeds
MANAGEMENT:
1. Clear nares/airway by having PT sit up and lean forward and blow nose.
2. Oxymetazoline nasal spray 2 squirts in each nostril.
3. Pinch anterior area of nose firmly for full 10 minutes WITHOUT RELEASING PRESSURE.
4. Assess for continued bleeding and have PT clear/blow nose.
5. If bleeding continues, pack with Afrin-soaked gauze bilaterally along floor of nasal cavity × 24 hours.
6. Once bleeding has stopped (after 30 minutes), remove the Afrin nasal sponge and apply Bactroban to the affected
SECTION 3 7. Clear clots and other material from airway (if required) by having patient sit up, lean forward, and blow his/her nose.
nostril bid – tid × 7 days.
8. If bleeding continues, pack with TXA-soaked gauze bilaterally along floor of nasal cavity × 30 minutes then execute
step 6).
9. IF BLEEDING CONTINUES despite packing or rebleeding occurs after 24 hours: Prepare 14 French Foley cath-
eter. (Tip is cut to minimize distal irritation). Advance catheter along floor of nose (straight in) until visible in mouth. Fill
balloon with 5mL of normal saline. Retract catheter until well opposed to posterior nasopharynx. Add an additional
5mL of normal saline to balloon. Clamp in place without using excessive anterior pressure. Moxifloxacin 400mg PO
qd until packing is removed. Leave balloon and packing in place for 72 hours.
DISPOSITION: Evacuation may not be required if epistaxis is mild, anterior, and resolves with treatment. Urgent evacu-
ation for severe epistaxis not responding to therapy or if Foley catheter is used.
SPECIAL CONSIDERATIONS:
1. Common at high altitude and in desert environments due to mucosal drying.
2. May be anterior or posterior.
3. Posterior epistaxis may be difficult to stop and may cause respiratory distress due to blood flowing into the airway.
This type of epistaxis is uncommon in young healthy adults. It is more commonly seen in older, hypertensive patients.

Flank Pain
(Includes Renal Colic, Pyelonephritis, Kidney Stones)
DEFINITION: Flank pain possibly caused by renal colic, pyelonephritis, or kidney stones.
S/Sx: Flank Pain; urinary tract infection (dysuria and/or polyuria); back pain; nausea/vomiting; costovertebral angle
tenderness; fever; hematuria.
MANAGEMENT:
1. Treat per Pain Management Protocol with ketorolac if kidney stone suspected.
2. Treat per Nausea and Vomiting Protocol.
3. Treat per Dehydration Protocol.
4. If fever present treat with antibiotics and evacuate:
a. Trimethoprim-sulfamethoxazole 1 tab PO bid OR amoxicillin/clavulanic acid 875mg PO bid.
b. Ceftriaxone 1g bid IV/IM OR ertapenem 1g IV/IM if unable to tolerate PO or unresponsive to oral treatment.
DISPOSITION: Priority evacuation
SPECIAL CONSIDERATIONS:
1. May progress to life-threatening systemic infection.
2. May be associated with testicular torsion. Ensure normal external GU exam first.

114 SECTION 3 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) & SICK CALL