Epistaxis

Question 1

What is Epistaxis?

Answer 1

Nosebleeds.

Question 2

What is Severe Epistaxis? (3)

Answer 2

1. Nosebleed that doesn’t stop after 10-15 minutes.
2. Bilateral.
3. Haemodynamic Unstable.

Question 3

Anatomy of Nose Vascular Supply (3).

Answer 3

1. Bleeding usually originates from Kiesselbach’s Plexus - Little’s Area.
2. Area of Nasal Mucosa at front of Nasal Cavity (very vascular).
3. Mucosal disruption = blood vessels are exposed.

Question 4

Aetiology of Epistaxis (6).

Answer 4

1. Nose Picking.
2. Colds, Sinusitis.
3. Vigorous Nose-Blowing, Trauma., Snorting Cocaine.
4. Changes to Weather.
5. Coagulation Disorders and Anticoagulants.
6. Tumours.

Question 5

What can cause bilateral bleeding (unilateral is commoner)?

Answer 5

Bleeding posteriorly in the nose (associated with a high risk of aspiration).

Question 6

Management of MILD Epistaxis (3).

Answer 6

1. Sit up and tilt head forwards.
2. Squeeze Soft Part of Nostrils for 10-15 minutes.
3. Spit, don’t swallow blood.

Question 7

Why should you not tilt the head backwards?

Answer 7

Blood will flow towards the airway.

Question 8

Management of SEVERE Epistaxis (3).

Answer 8

1. Hospital Admission.
2. Nasal Packing - Nasal Tampons/Inflatable Packs.
3. Nasal Cautery - Silver Nitrate Sticks (if source of bleeding is visible).

Question 9

Long-Term Management after SEVERE Epistaxis.

Answer 9

Naseptin Nasal Cream (Chlorhexidine and Neomycin) - reduce crusting, inflammation and infection.

Question 10

Contraindication of Naseptin.

Answer 10

Peanut/Soya Allergy.

Question 11

What is Nasal Cautery? (3)

Answer 11

1. Blow nose to remove clots.
2. Local Anaesthetic Spray.
3. Apply Silver Nitrate Stick for 3-10 seconds until bleeding point becomes grey.

Question 12

Surgical Management of Epistaxis.

Answer 12

Sphenopalatine Ligation in Theatre.