Epistaxis

Question 1

Causes of epistaxis

Answer 1

• trauma
• nose picking
• foreign body
• bleeding disorders
• HHT and GPA

Question 2

Epistaxis initial management

Answer 2

• ask patient to lean forward with their mouth open
• pinch soft part of nose for 20 minutes
• breathe through the mouth
• if bleeding successfully stopped, give Naseptin (chlorhexidine + neomycin) to reduce crusting and vestibulitis
• use Muciprocin if allergies
• give lifestyle advice

Question 3

Epistaxis further management

Answer 3

A to E approach
A - obstructive clots
B - tachypnoea
C - tachycardia, O2 sats, cap refill, hypovolaemia
D - hypoglycaemia
- group and save, cross-match

Question 4

If bleeding source visualised

Answer 4

• lidocaine local anaesthetic spray and then wait 3-4 mins
• dab with adrenaline cotton ball
• apply silver nitrate stick for 3-10 seconds until it turns white
• clean area and apply Naseptin

Question 5

If bleeding source not visualised

Answer 5

anterior nasal packing:
- nasal tampon
- rapid Rhino
- insert horizontally - proximity to septum
posterior nasal packing:
- 16-18G Foley inflated with 10ml water
if still bleeding:
- examination under anaesthesia
- possible sphenopalatine artery ligation

Question 6

Kiesselbach’s plexus

Answer 6

• Labial (superior) artery
• Ethmoidal (anterior and posterior)
• Greater palatine artery
• Sphenopalatine artery