Epistaxis Flashcards
What are the types of nosebleeds and where do they come from?
Anterior nosebleed
- Bleeding occurs from Kisselbach’s plexus (an anastomosis of five arteries)
Posterior nosebleed
- Comes from sphenopalatine artery
What are the risk factors for epistaxis?
Digital or other trauma
Infection
Tumours
Septal deviation
Hypertension
Anticoagulants
NSAIDs
Bleeding disorders
Illicit drug use
What is the presentation of epistaxis?
Bleeding from the nares
Feeling of blood in the throat
Pain
Blood visible in the oropharynx
Pseudohaematemesis
Severe:
- Dizziness and pre-syncope
- Shock
- Tachycardia
What makes an anterior bleed more likely?
Visible source of bleeding
Minor bleeding
Unilateral bleeding
History of digital trauma
First-aid measures successfully control bleeding
What makes a posterior bleed more likely?
No visible source of bleeding
Bleeding in the back of the mouth and throat
Bleeding initially bilateral
Visible blood in the posterior pharynx
Pseudohaematemesis
Anterior nasal packing fails to control bleed
What is the initial management of epistaxis?
Advise patients on how to manage nosebleed
- Sit up and tilt head forwards
- Squeeze the soft part of the nostrils together for 10-15 minutes
- Spit out any blood rather than swallowing it
What is the further management of epistaxis?
Nasal packing using nasal tampons or inflatable packs
Nasal cautery using silver nitrate sticks
What is the longer term management of epistaxis?
Naseptin nasal cream to be used QDS for 10 days
- Contraindicated in peanut or soya allergy
What is the management of a posterior nosebleed?
Posterior nasal packing - undertaken by ENT specialist
What advice should be given to patients on discharge?
Do not lie flat for 24 hours
Avoid nose-blowing for one week
Avoid alcohol, hot drinks and spicy food for 2 days
Avoid strenuous exercise for 1 week
Avoid dislodging scabs and nose-picking
