Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Concept Videos

Epistaxis01:30

Epistaxis

801
Epistaxis, or nosebleeds, occurs when small, swollen blood vessels in the nasal mucous membrane rupture. Typically, the anterior septum is the primary site of occurrence.
Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...
801
Cardiopulmonary Resuscitation II: ACLS Airway Management01:22

Cardiopulmonary Resuscitation II: ACLS Airway Management

1.1K
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
1.1K
Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques01:30

Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques

877
Airway management is essential in emergency and surgical medicine, ensuring ventilation and oxygenation in patients who cannot maintain their own airway. Clinicians use a range of techniques and devices to secure the airway, depending on the patient’s condition and the clinical context. Key methods include endotracheal intubation, rapid sequence intubation (RSI), supraglottic airway devices, and advanced visualization aids. In cases where these approaches fail, surgical airway...
877

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by
Same author

The Musculoskeletal Consequences of Mouth Breathing in Adults: A Systematic Review.

The Laryngoscope·2026
Same author

Preoperative Pollen Exposure and Chronic Rhinosinusitis Outcomes After Endoscopic Sinus Surgery: A Pilot Investigation.

Laryngoscope investigative otolaryngology·2026
Same author

Proposed changes to current definitions of ICHD-3 regarding headache and facial pain attributed to the disorder of the nose or paranasal sinuses.

Cephalalgia : an international journal of headache·2026
Same author

Determining the Minimal Clinically Important Difference of the 40-Item Smell Identification Test in People With Cystic Fibrosis.

International forum of allergy & rhinology·2026
Same author

Digital Health Access and Use Among Patients Presenting to a Tertiary Rhinology Center.

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery·2026
Same author

The nature of nasal discharge in chronic rhinosinusitis: a systematic review and meta-analysis using patient-reported outcomes.

Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale·2025

Related Experiment Video

Updated: Apr 16, 2026

The Rigid Tube as an Alternative in Controlling the Problematic Airway
08:26

The Rigid Tube as an Alternative in Controlling the Problematic Airway

Published on: June 6, 2020

7.0K

Developing a laddered algorithm for the management of intractable epistaxis: a risk analysis.

Randy M Leung1, Timothy L Smith2, Luke Rudmik3

  • 1Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Royal Victoria Regional Health Centre, Barrie, Ontario, Canada.

JAMA Otolaryngology-- Head & Neck Surgery
|February 27, 2015
PubMed
Summary

For intractable epistaxis, a stepwise approach using transnasal endoscopic sphenopalatine artery ligation (TESPAL) and posterior packing offers the lowest risk. This strategy prioritizes patient safety and effective management of severe nosebleeds.

More Related Videos

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
04:46

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

Published on: January 17, 2011

22.3K
Image Acquisition using Portable Sonography for Emergency Airway Management
07:31

Image Acquisition using Portable Sonography for Emergency Airway Management

Published on: September 28, 2022

3.2K

Related Experiment Videos

Last Updated: Apr 16, 2026

The Rigid Tube as an Alternative in Controlling the Problematic Airway
08:26

The Rigid Tube as an Alternative in Controlling the Problematic Airway

Published on: June 6, 2020

7.0K
A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
04:46

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

Published on: January 17, 2011

22.3K
Image Acquisition using Portable Sonography for Emergency Airway Management
07:31

Image Acquisition using Portable Sonography for Emergency Airway Management

Published on: September 28, 2022

3.2K

Area of Science:

  • Otolaryngology
  • Interventional Radiology
  • Health Economics

Background:

  • Intractable epistaxis management options include posterior packing, transnasal endoscopic sphenopalatine artery ligation (TESPAL), and embolization.
  • The optimal sequence for these interventions to minimize patient risk remains unclear.
  • Cost-effectiveness analyses favor TESPAL, but patient-centered risk assessment is crucial.

Purpose of the Study:

  • To quantify the risks associated with different management strategies for intractable epistaxis.
  • To inform clinical decision-making by comparing the risk profiles of various treatment sequences.

Main Methods:

  • A risk analysis was conducted using literature-derived probabilities of treatment failure and adverse events.
  • The analysis modeled a 50-year-old male patient with no comorbidities.
  • Six management algorithms combining posterior packing, TESPAL, and embolization were evaluated, with total risk quantified in US dollars.

Main Results:

  • Sequences initiating with posterior packing or TESPAL demonstrated similarly low risks.
  • The lowest-risk strategies were Posterior packing-TESPAL-Embolization (P-T-E), TESPAL-Posterior packing-Embolization (T-P-E), and TESPAL-Embolization-Posterior packing (T-E-P).
  • Embolization as a first-line treatment significantly increased total risk due to cerebrovascular event risks.

Conclusions:

  • Laddered treatment approaches utilizing TESPAL and posterior packing are associated with the lowest patient risk.
  • A recommended strategy involves prioritizing TESPAL first, followed by embolization or posterior packing, balancing risk and cost-effectiveness.