epistaxis

Question 1

causes of epistaxis

Answer 1

nose picking, blowing
trauma
foreign bodies
bleeding disorders: immune thrombocytopenia, waldenstrom’s macroglobulinaemia
juvenile angiofibroma
cocaine
hereditary haemorrhagic telangiectasias
granulomatosis with polyangiitis

Question 2

first line management of epistaxis- first aid measures

Answer 2

patient to sit with their torso forward and mouth open
pinch cartilaginous area of the nose firmly

Question 3

second line management of epistaxis if first aid is successful

Answer 3

consider topical antiseptic (naseptin)
admit if patient has co-morbidities

Question 4

management of epistaxis if bleeding does not stop after 10-15 mins

Answer 4

consider cautery: if the source of bleeding is visible
- use topical anaesthetic spray then cauterise
packing: used if cautery is not viable or bleeding cannot be visualised
- use topical anaesthetic
- patient should be admitted and reviewed