Objectives The aim of this study was to assess the efficacy of a new emergency department intervention for the management of epistaxis, aiming to reduce epistaxis admissions. Design Tranexamic acid (TXA) (500mg/ml) soaked NasoPore® packing was in the pathway for epistaxis which did not terminate following 10 minutes of simple first aid. The pathway was utilised for adult patients presenting with non-traumatic, anterior epistaxis. Pre- and post-implementation admission rates and re-attendance rates were recorded by retrospective audit at a large central London hospital. Results Epistaxis admissions were reduced by 51.7% (p<0.05) following the implementation of the TXA-soaked NasoPore® pathway. Conclusions The significant reduction in epistaxis admissions demonstrates that this intervention is beneficial for patient outcomes. This has the potential to be introduced in other A&E departments and also pre-hospital settings.

Background Current shortage of operative space and anaesthetic staff led to 531907 ENT cases waiting to be performed as of June 2022; a trend expected to worsen. Awake surgery can provide a safe and effective alternative reducing the need for anaesthetic cover while utilising alternative operating spaces. Methodology Prospective cohort study of 86 patients undergoing ENT procedures under local anaesthetic with/without operator delivered sedation using midazolam; performed in the ambulatory Procedure Zone of an ENT tertiary centre in the UK by a single sedation trained rhinologist. Results N=54 inferior turbinate reduction (n=19 with radiofrequency ablation, n=25 with co-ablation, n=13 combined with a second procedure). Pre-operative mean SNOT23 score 59, mean NOSE score of 17.89, 3 month post-operative mean SNOT 23 score 36 and mean NOSE score 7.92 (P<0.05). N=18 balloon sinoplasty, n=4 endoscopic sinus procedures; pre-operative mean SNOT23 score 76, 3 month post-operative mean SNOT23 score 25 (P<0.05). N=12 nasal biopsies, n=8 septoplasties, n=6 adhesiolysis, n=1 grommet insertion, n=1 excision of pinna lesion, n=1 canal polypectomy. Visual analogue scale was used to assess patient comfort during the procedure; 4/10 mean score (IQR 2-8) for cases under local anaesthetic ranged, with addition on sedation comfort increased with mean score of 8/10 (IQR 1-10). Due to the low numbers of cases statistical significance was not calculated. Conclusion Awake surgery in ENT is a safe and effective alternative to general anaesthesia. It is a cost effective service, which shortens waiting and treatment times, and coupled with operator delivered sedation leads to high patient satisfaction rates.