RhinoPinch Nasal Clip

The Clinical Need Behind Innovation

Dr Akuafo Agbenyega

EpistaxisFirst Aid

And Clinical Management

Epidemiology

• This is unknown in most ED around the world

• 1599 patients attended Crosshouse ED – 5yrs

• 1 to 2 visits to ED per 1,000 population, occurred annually for E and N Ayrshire

• 4x more common above 50yrs than <25yrs

• 32% of these patients were admitted

• 68% were discharged home

Scottish Literature

• Investigation of Scottish hospital 1995–2004• Single most frequent emergency diagnosis in ENT• Common condition that places considerable

demands on ENT staff and services in the UK • Accounts for about 33% of ENT admission• Median age for admission - 70years• More admissions in winter than summer and

holidays/weekends• Most cases can be controlled and treated in the

ED or ENT outpatient department

Other literature• Epistaxis affects all age groups

• Bimodal incidence <25yrs or >50yrs of age

• 7x more in ages above 50yrs

• Majority are anterior bleeds – Little’s area(80%)

• In USA 60% of population are estimated to have had at least one episode of epistaxis throughout their life time

• 6% seek medical care and require treatment

• About 1 in 200 ED visits are for epistaxis

• Accounts for 1 to 2 visits /1000 US pop

The problem – The Need• Epistaxis is common in the community

• Increase in elderly population

• Knowledge of first aid treatment amongst public and some health professionals is poor– Understanding vascular anatomy in epistaxis– Nasal pressure can be difficult, restrictive and

time consuming for patients and medical staff– Unnecessary use of emergency services– Inadequate advice for discharged patients

Pathophysiology• Rapture of vessels - spontaneous or traumatic• Hypertension• Increased blood flow – cold, infection, alcohol• Drugs, Anticoagulants• Hematological cancers and blood dyscrasias• Elderly – thin dry mucosa, hypertension, vessels• Winter – low relative humidity of air

– 80% bleeds are anterior – Kiesselbachs plexus (Little’s area)

– Posterior bleed – rapture of sphenopalatine artery or one of the branches

Kiesselbach's plexus or Little's area, • Anteroinferior part of the nasal septum

Anatomy of little’s area

Management

Management• 3 Step approach

– Pressure (The RhinoPinch Clip) • Direct pressure on soft fleshy part of nose• Pressure should be firm for at least 10 mins

– cautery, • Silver nitrate

– packing • Merocel / Rapid Rhino

• Consider posterior Bleed

• Advice – Verbal and Written

RhinoPinch Nasal Clip» New device» Background – Crosshouse ED» First Aid Treatment for all epistaxis» Will prevent the unnecessary attendance to hospital –

ambulance crew can apply» Time saving device – apply in triage» Apply to buy time while preparing for more complicated

treatment» First aid kits, Schools, Sports, Hospitals , Nursing

Homes, Airlines, Supermarkets, Public places» Will provide needed advice for patients and the public