Epistaxis

Question 1

Epistaxis: Causes

Answer 1

nose picking
HTN
coagulation disorders
anti coagulants
nose fracture
major facial injury

Question 2

site of bleeding

Answer 2

MC -ant nasal septum or close to Little’s area

post nasal septum -brisk bleeding

Question 3

Equipment for inspection

Answer 3

-headlamp (eg battery-operated head torch)
-a fine soft suction catheter
-a nasal speculum
-goggles to avoid blood splashes in the eyes.

Question 4

Epistaxis ass with facial injury

Answer 4

ABCDE
resuscitate as necessary
Tx hemorrhagic shock

Question 5

Epistaxis ass without facial injury

Answer 5

Check airway, pulse, and BP
-treat hypovolemia
-check coagulation status of patients on anticoagulants and treat appropriately
-sit the patient up
-instruct them to compress the fleshy part of their nose between their finger
and thumb for 10min
-If bleeding stops, the patient may be discharged after
30min observation

Question 6

continuing bleeding after pressure- adults

Answer 6

-Apply a cotton wool pledget soaked in lidocaine with phenylephrine.
-with a headlamp and a nasal speculum, try to identify the bleeding
point.
-Treat small anterior bleeding points with cautious cautery by applying a silver nitrate stick for 10–15s.
-Avoid excessive cautery, and never cauterize
both sides of the septum—this may cause septal necrosis.
-If cautery stops the bleeding, observe for 15min, and discharge with GP follow-up.
-Advise avoidance of sniffing, picking, or blowing the nose in the meantime.

Question 7

continuing bleeding after pressure- children

Answer 7

nasal antiseptic cream (eg Naseptin®) is as effective as
cautery in stopping bleeding

Question 8

cautions with Naseptin cream

Answer 8

avoid if there is a history of peanut, soya, or neomycin allergy

Question 9

Continuing bleeding despite cautery

Answer 9

anterior nasal packing”

1.compressed nasal tampon (eg Merocel®)
-inflatable pack (Rapid
Rhino®)
-refer to ENT

Question 10

The caution with ant packing

Answer 10

the pack may dislodge and can cause airway obstruction

Question 11

continuing bleeding despite packing

Answer 11

refer to ENT
send blood samples
cross match
2 large bore IV cannulas
start IVI
post nasal packing

Question 12

complication with post nasal bleeding

Answer 12

hypovolemic shock

Question 13

how to do a post nasal packing

Answer 13

Remove the nasal tampon, and insert a lubricated, uninflated Foley catheter
through the bleeding nostril into the nasopharynx. Inflate the balloon with
air, and gently withdraw the catheter, thus tamponading the bleeding site.
Tape the catheter to the cheek, then re-insert the anterior tampon.