A 60-year-old hypertensive male presents with profuse posterior epistaxis not controlled by anterior nasal packing. He is normotensive with resuscitation. The next step is:

• A Repeat anterior nasal packing with higher-volume Foley balloon
• B Posterior nasal packing (Brighton or Foley catheter posterior pack) + anterior pack ✓
• C Endoscopic sphenopalatine artery ligation as first-line intervention
• D Emergency external carotid artery ligation

Explanation

Posterior epistaxis arises from branches of the sphenopalatine artery and cannot be controlled by anterior packing alone. The standard next step after failed anterior packing is posterior nasal packing (using a 12–16Fr Foley catheter balloon inflated with 8–10 mL saline in the nasopharynx, secured anteriorly) combined with anterior packing. Endoscopic sphenopalatine artery (SPA) ligation is performed if posterior packing fails or is not tolerated. External carotid ligation is a last resort.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.