Epistaxis (1*)

Question 1

Where does it usually come from?

What are the triggers of it?

What may a pt present with if they swallow that blood?
→ In which type of bleed is this more likely?

Answer 1

➊ Kiesselbach’s plexus, which is in Little’s area in the front of the nasal cavity

➋ Nose picking, Vigorous nose-blowing, Trauma, Anticoagulants, Coagulopathy, Tumours, Snorting drugs

➌ Haematemesis
→ Bilateral bleeding as this may indicate posterior bleeding

Question 2

Management:
What is 1st line?
→ What does this include?
→ Why is this done?

What should be done if there’s no improvement after 10-15 minutes?

What should be done if recurrent and significant bleeds?

Answer 2

➊ Direct compression -
→ Sit up, tilt head down, Squeeze cartilaginous part of nose, and open mouth for 10-15 mins
→ Leaning forward decreases blood flow through the nasopharynx, allows spitting out of blood, and minimises swallowing blood that drains into the pharynx

➋ Nasal cautery, then packing

➌ Refer for further investigations to look for an underlying cause