Epistaxis Flashcards
What is epistaxis?
Epistaxis, or nose bleeds, is divided into anterior and posterior bleeds. Anterior bleeds often have a visible source and are due to capillary insult in Kiesselbach’s plexus, while posterior bleeds are more profuse and originate from deeper structures.
What are common causes of epistaxis?
Common causes include nose picking, nose blowing, trauma, foreign bodies, bleeding disorders, immune thrombocytopenia, Waldenstrom’s macroglobulinaemia, juvenile angiofibroma, cocaine use, hereditary haemorrhagic telangiectasia, and granulomatosis with polyangiitis.
What first aid measures can be taken for epistaxis?
If the patient is haemodynamically stable, ask them to sit forward with their mouth open, pinch the soft area of the nose for at least 20 minutes, and breathe through the mouth.
What should be done if first aid measures for epistaxis are successful?
Consider using a topical antiseptic like Naseptin to reduce crusting and risk of vestibulitis, unless the patient has allergies to peanut, soy, or neomycin. Mupirocin is an alternative.
When should a patient with epistaxis be admitted for follow-up care?
Admission may be considered if there is a comorbidity, an underlying cause is suspected, or if the patient is under 2 years old.
What self-care advice should be given to patients after an epistaxis episode?
Patients should avoid blowing or picking their nose, heavy lifting, exercise, lying flat, drinking alcohol, or consuming hot drinks.
What should be done if bleeding does not stop after 10-15 minutes of pressure?
Consider cautery or packing. Cautery should be used if the source of the bleed is visible and tolerated.
How should cautery be performed for epistaxis?
Use a topical local anaesthetic spray, wait 3-4 minutes, identify the bleeding point, and apply silver nitrate stick for 3-10 seconds until it becomes grey-white. Avoid touching non-bleeding areas.
What is the procedure for nasal packing in epistaxis?
Anaesthetise with a local anaesthetic spray, pack the nose while the patient is sitting forward, and monitor for cosmetic changes around the nostril.
When should patients with epistaxis be admitted to the emergency department?
Patients who are haemodynamically unstable or have a bleed from an unknown or posterior source should be admitted.
What may be required for epistaxis that fails all emergency management?
Sphenopalatine ligation in theatre may be required.
