epistaxis

Question 1

history of epistaxis

Answer 1

frequency
duration
which side or both
blood dripping out of nose or down back of throat or both
what did u do when it started
history of previous bleeds
previous treatment 
previous nasal surgery
picked nose
PMH: HTN, chronic granulomatous diseases, bleeding disorders, rhinitis
DH: aspirin, warfarin, clopidogrel, NOAC

Question 2

examination in epistaxis

Answer 2

anterior rhinoscopy
posterior rhinos copy - nasal endoscope
inspect external nose for trauma, scarring, discharge

Question 3

management of acute epistaxis

Answer 3

ABCDE
make sure IV access is available
cannula
bloods: FBC, coagulation profile, group and save
if possible identify vessel and cauterise
if can’t identify vessel, admit and anterior pack
still bleeding through anterior pack, posterior pack (usually last 48 hours)
if bleeding continues, ligate artery
if packs have been in >48 hours prescribe AB to prevent infection

Question 4

causes of epistaxis

Answer 4

idiopathic
trauma - blunt or nose picking aka digital trauma
inflammatory e..g chronic granulomatous disease or sarcoidosis
acute or chronic rhino sinusitis
drugs: aspirin, clopidogrel, warfarin, LMWH
haematological: DIC, ITP
neoplasia of nasal cavity
iatrogenic: recent nasal surgery

Question 5

advice following epistaxis

Answer 5

don't blow nose or clean nose
avoid hot baths/showers
let food cool down
no hot tea and coffee for first 72 hours
no strenuous exercise
avoid spicy food
warn of reoccurrence and tell to apply firm pressure for 15 minutes, if it won't stop A and E

Question 6

management of non acute epistaxis

Answer 6

cauterise - NEVER both sides of the septum at the same time could damage blood supply and cause the nose to become perforated
nasal ointment for 1-2 weeks to keep nasal cavity free of crust - contains peanuts check for allergy