Intranasal Topical Application of Tranexamic Acid in Atraumatic Anterior Epistaxis

Original paper





  • Intranasal topical TXA is associated with a lower rate of need for anterior nasal packing and a shortened stay in the ED

Bottom line

  • Topical TXA for epistaxis is slowly gaining traction despite recent negative study (NoPAC)
  • This RCT fits author’s own experience- ineffective for posterior bleeding, delayed presentations or traumatic epistaxis, but no harm and better tolerated than balloon tamponade device (RapidRhino etc)

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Efficacy of empiric abx for septic olecranon bursitis without aspiration in ED


  • In this series, 84% of patient was discharged from ED, 55.3% with antibiotic. Only 1.5% had elbow aspiration in ED. 88% had resolution at follow-up.

Bottom line

  • Author concluded that aspiration in ED is not necessary even when septic bursitis is suspected, and most can be managed with outpatient antibiotic
  • Performing a CRP blood test, and/or referral to orthopedic service, is associated with admission and antibiotic administration
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Case of the Week 25

A 25-year-old man presented to the emergency department after a motorbike accident on the freeway. On the scene, his blood pressure was 90 systolic, HR 110. He is in spinal precaution and is significantly distressed due to pain.

During his assessment, a pelvic X-ray was obtained.

Interpret the X-ray.

Image courtesy-

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Case of the week 24

A 32-year-old female is brought by ambulance to the ED. She was a driver of a small hatchback car, which was hit by another car on the passenger side on Marmion ave an hour ago. She is 32 weeks pregnant. The patient is in the resuscitation cubicle, with full cardio-respiratory monitoring and spinal immobilization. The hospital trauma call has done by Triage nurses already.

Her Vitals- GCS-15, HR- 130, BP- 90/60, RR- 24, Sats- 99% (6 L/min Oxygen)

  • What are the key features of your initial assessment?

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Case of the week 22

On a busy night shift, the medical emergency alarm went off in the EAU area. A 33-year-old lady who was receiving the first unit of PRBC for her anemia complicated by the menorrhagia, feeling very unwell and dizzy.

Vitals- HR120, BP- 80/50, RR- 36, Temp-39

  • Outline your differential diagnosis and initial response to that situation.

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Case of the week 21

Handover at 0800- 53-year-old Indian presenting to hospital with severe neck pain. History is difficult to attain because of the language barrier. The night RMO has sent some blood and gave her some analgesics, including a 5 mg tablet of Oxycodone.

The RMO thinks the patient will need further assessment.

  • How will you approach the situation?

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