8. Epistaxis (nosebleeds) - workbook

Question 1

what are simple first-aid measures in treating epistaxis (nosebleeds)?

Answer 1

pinching IN FRONT OF not on the bony bridge of nose

applying cold compress

Question 2

where is the arterial supply to the nasal cavity mainly from?

Answer 2

branches of the maxillary artery (sphenopalatine and greater petrosal)
Ethmoidal branches (from opthalmic, from ICA)
branch of the facial artery
(contributing to nose’s rich blood supply)

Question 3

how many arteries are there supply the nose?

Answer 3

anastomosis of 5 arteries

Question 4

where is the anastomosis of the 5 nasal arteries?

Answer 4

on the cartilaginous part of the septum known as Little’s Area

Question 5

what is Little’s Area also known as? (anastomosis)

Answer 5

Keiselbach’s area / plexus

Question 6

what is Little’s Area the site of?

Answer 6

origin for most nosebleeds (90%)

Question 7

aside from Little’s Area, where else do nosebleeds arise from?

Answer 7

sphenopalatine artery

Question 8

why can bleeds of sphenopalatine artery be particularly problematic?

Answer 8

as blood in sphenopalatine vessel tend to be at high pressure

Question 9

where is sphenopalatine vessel located?

Answer 9

posteriorly located in the nasal cavity - harder to reach to stop bleeding

Question 10

how can nosebleeds occur?

Answer 10

spontaneously / very minor trauma to the nose e.g. nose picking, blowing nose

Question 11

aside from minor causes, how else can nosebleeds arise?

Answer 11

underlying systemic causes e.g. abnormal coagulation and CT disorders

Question 12

which age-group do nosebleeds commonly occur in?

Answer 12

very young (2-10 years)
old (>50-60 years)

Question 13

what can serious nosebleeds lead to?

Answer 13

potentially risk significant blood loss

rarely even death

Question 14

what should management of epistaxis be?

Answer 14

initially applying simple compression and leaning forward - should stop most nosebleeds

Question 15

if applying simple compression and leaning forward doesn’t stop the epistaxis, then what should be done?

Answer 15

cauterise a visible bleeding point using silver nitrate

Question 16

what should be done if bleeding is significant or the bleeding point cannot be identified?

Answer 16

cautery may prove difficult

anterior packing using nasal tampons can be used

Question 17

what is cauterise?

Answer 17

burn the skin or flesh of (a wound) with a heated instrument or caustic substance in order to stop bleeding or to prevent infection

Question 18

how do nasal tampons (anterior packing) work?

Answer 18

they expand within the nasal cavity and tamponade the area of bleeding

Question 19

if bleeding still continues despite anterior packing, then what should be done?

Answer 19

posterior packing

surgical intervention e.g. embolisation (last resort) - ligation of blood vessels

Question 20

what should be monitored in severe epistaxis?

Answer 20

the patient’s ABC
blood tests taken to check their Hb levels and clotting
any underlying systemic causes for bleeding should also be sought and treated

Question 21

what can be an underlying systemic causes for bleeding?

Answer 21

coagulopathies

Question 22

what is coagulopathies?

Answer 22

the blood’s ability to coagulate (form clots) is impaired (bleeding disorder)