Epistaxis

Question 1

Two types of epistaxis?

Answer 1

Anterior and posterior bleeds.
Anterior - Visible bleeding and usually due to insult to Kiesselbach’s plexus.
Posterior - Profuse and originate from deeper structures. Suspect if bleeding from both nostrils

Question 2

What are the causes of epistaxis?

Answer 2

Digital trauma,
Trauma to nose,
Insertion of foreign bodies,
Bleeding disorders,
Juvenile angiofibroma,
Cocaine use,
Hereditary haemorrhagic telangiectasia,
GPA.
Anticoagulants.

Question 3

What is the management of epistaxis if haemodynamically stable?

Answer 3

first aid measures -Avoid lying down (sit up and learn forward) and pinch the cartilaginous (soft) area of the nose for 20mins.

Then if successful then use naseptic to reduce crusting (contraindicated with peanut/soy allergies), admit if co-morbid or <2 and self care advice.
If bleeding does not stop within 10-15mins of continuous pressure then consider cautery (bleeding vessel visible) or packing (vessel cannot be visulised).

Question 4

What is the management of epistaxis if haemodynamically unstable?

Answer 4

Admission to ED - control with first aid measures in interim.
If doesn’t respond to cautery or packing then sphenopalatine ligation in theater.