Question: Can ACPs use xylometazoline nasal spray to aid in the treatment of epistaxis? It seems to be the go to start to treatment in the Emergency Department, why not get started prehospital?

The ALS PCS v.4.4 does not allow the use of Xylometazoline (Otrivin) for the treatment of epistaxis.

There is no known published evidence that Xylometazoline is of any benefit in treating epistaxis. There is scant evidence that it is of benefit in reducing the incidence of epistaxis during naso-tracheal intubation (1). This is why it is in the ALS PCS for that indication. However, it appears that the incidence of epistaxis in naso-tracheal intubation is more related to the type of tube used rather than the use of Xylometazoline itself (2).

That being said, Xylometazoline might theoretically be beneficial in the treatment of epistaxis as it is a vaso-constrictor. Where it is used for this, it is based on personal experience or anecdotal evidence. There is no research evidence to support its use in epistaxis prehospital setting, let alone the hospital setting.

1. El-Seify, Z.A. et. al., Xylometazoline pretreatment reduces nasotracheal intubation-related epistaxis in paediatric dental surgery. Br J Anaesth. 2010 Oct;105(4):501-5. doi: 10.1093/bja/aeq205

2. O'Hanlon J1, Harper KW.Epistaxis and nasotracheal intubation--prevention with vasoconstrictor spray. Ir J Med Sci. 1994 Feb;163(2):58-60.

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