Technical tutorial: How to pack a nose with bismuth iodoform paraffin paste gauze safely and effectively.

The current primary treatment for epistaxis in accident and emergency departments is the insertion of Merocel packs. If these are properly inserted, but fail to control bleeding, it is necessary to insert a bismuth iodoform paraffin paste (BIPP) pack. A BIPP pack, when properly inserted, has the potential to stop most bleeds, but books and journals suggest a method of insertion that limits its effectiveness. A safer and more effective way of packing a nose with BIPP than the traditional method is described.