Epistaxis

Question 1

where do 90 percent of epistaxis occur?

Answer 1

Kiesselbach’s plexus

little’s area

Question 2

causes epistaxis?

Answer 2

• idiopathic
• mostly trauma (nose-picking, foreign bodies, surgery)
• infection/inflammation (URTI, rhinitis, granulomatosis with polyangiitis - Wegner’s, TB, syphilis)
• tumour (SCC, juvenile angiofibroma - recurrent nosebleed in teenage boys)
• coagulopathy (warfarin, leukaemia, VW disease, haemophilia, hepatic coagulopathy)
(HT exacerbates, but does not cause)

Question 3

Ix epistaxis?

Answer 3

only if severe or recurrent

• bloods: FBC, LFT, coag, group and save

Question 4

Tx epistaxis?

Answer 4

• ABCDE, IVT, O2
• pinch lower nostrils for 10 mins
• sit up and forward
• nose peg, ice

TOPICAL
• vasoconstrict with Adr (spray or soaked pleget/guaze) +/- lidocaine
OR oxymetazoline spray
• antifibrinolysis with tranexemic acid via soaked gauze

CAUTERY/PACKING
• thudicum’s speculum
• cauterise identified vessel - lidocaine then silver nitrate (1st) or thermal (2nd)
• OR insert packing

FURTHER (eg if severe posterior bleed)
• Foley catheter
• surgical ligation of artery
• embolised radiologically

Question 5

what to remember when cauterising in bilateral epistaxis?

Answer 5

NEVER CAUTERISE BOTH SIDES OF THE SEPTUM

risk of impaired septal supply and perforation

Question 6

Sx: epistaxis and facial pain or otalgia?

Answer 6

may indicate a nasopharyngeal tumour (including angiofibroma)