# Introduction

The SARS-CoV-2 (COVID-19) pandemic led to necessary changes in the management of common ENT emergency presentations internationally. Epistaxis is the most common emergency presentation to ENT,1 with a patient presenting to UK in-hospital ENT teams every other day on average.2 Several aspects of epistaxis management were considered to pose a risk of COVID-19 spread. Firstly, COVID-19 resides principally in the airway,3,4 and so instrumentation of the upper aerodigestive tract (as indicated in the management of epistaxis) is a known risk factor for droplet formation and aerosol generation.5,6 Secondly, non-dissolvable intranasal packs have traditionally been associated with hospital admission which, at the height of the initial peak of the pandemic, would have meant exposure to an environment with a higher prevalence than found in the community.7,8
In March 2020, new UK guidelines were issued for the management of epistaxis presenting to emergency departments (ED), in light of COVID-19.9 The major shifts in practice proposed were: the use of dissolvable intranasal products (in particular by the ED), the avoidance of non-dissolvable packs; and the discharge of suitable patients once bleeding cessation is achieved. These changes presumably aimed to: minimise the personnel involved in managing the acute presentation; reduce intranasal instrumentation; reduce admission rates, with the ultimate goal of preserving hospital bed capacity for the anticipated COVID-19 demand; and avoid unnecessary interactions with healthcare services.
The implementation of these guidelines resulted in inevitable changes to established practices, shown to be safe over many years of epistaxis care. However, the safety of these new practices has not been assessed.
This article aims to:

1. Report the findings of a 12-week prospective audit of acute epistaxis care, conducted during the initial peak of COVID-19 in the UK.
2. Explore factors relating to unscheduled re-presentation to hospital in epistaxis patients discharged from the ED.