Contributor: Jared Scott, MD Educational Pearls: The ED is full of painful procedures. One of the most commonly dreaded procedures is nasal packing for epistaxis, as it is quite uncomfortable for the patient.  A recent study compared TXA with compression, saline with compression, and traditional nasal packing for the treatment of epistaxis.  Hemostasis was achieved in 91% with TXA and compression, 93% with nasal packing, and 71% with saline and compression. There was no statistically significant difference between the packing and TXA groups. Furthermore, there was no difference in rates of rebleeding between the TXA and packing groups. However, 15% of nasal packing patients demanded removal of the packing due to pain.  Consider TXA (on gauze or atomized) for your next patient with epistaxis! References Akkan, Sedat et al.. Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial. Annals of Emergency Medicine, Volume 74, Issue 1, 72 - 78 Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD