Epistaxis

Question 1

Causes

Answer 1

Nose picking/ blowing

Trauma

Insertion of foreign bodies

Bleeding disorders

Juvenile angiofibroma

Cocaine use

Hereditary haemorrhagic telaniectasia

Granulomatosis with polyangitis

Question 2

Juvenile angiofibroma

Answer 2

Benign tumour that is highly vascularised

Seen in adolescent males

Question 3

Haemodynamically stable management

Answer 3

Sit with torso forward and mouth open

Pinch cartilaginous area firmly

Question 4

Management later

Answer 4

Consider topical antiseptic (naseptin) to reduce risk of crusting and vestibulitis

Admission and follow up of comorbid/ aged under 2

Self-care around risk of re-bleeding

Question 5

If bleeding does not stop in 10-15 minutes

Answer 5

Cautery if source of bleed is visible

Packing if not

Question 6

Haemodynamic instability

Answer 6

COntrol bleeding with first aid measures in interim

Admit to hospital if bleed from unknown or posterior cause

Question 7

Failed emergency management

Answer 7

May require sphenopalatine ligation in theatre