ENT: Epistaxis

Question 1

what is epistaxis?

Answer 1

nosebleeds

Question 2

where do nose bleeds originate from?

Answer 2

Kiesselbach’s plexus

also known as “little’s area”

this is an area of the nasal mucosa at the front of the nasal cavity

Question 3

what is the management of a nose bleed?

Answer 3

Sit up and tilt the head forwards. Tilting the head backwards is not advised as blood will flow towards the airway.

Squeeze the soft part of the nostrils together for 10 – 15 minutes

Spit any blood in the mouth out rather than swallowing

Question 4

When bleeding does not stop after 10 – 15 minutes, the nosebleed is severe, from both nostrils or they are unstable, patients may require admission to hospital. What are the treatment options?

Answer 4

Nasal packing using nasal tampons or inflatable packs

Nasal cautery using a silver nitrate stick

Question 5

a nosebleed doesn’t usually need medical intervention, but what could you consider prescribing for aftercare?

Answer 5

naseptin (chlorhexidine and neomycin) four times daily for 10 days to reduce any crusting, inflammation and infection.

This is contraindicated in peanut or soya allergy.

Question 6

how would you examine a nose bleed in an emergency situation?

Answer 6

ABCD

circulation consists of:

• Pulse
• Blood pressure
• Capillary Refill
• Is the patient shocked or not?