Epistaxis

Question 1

Definition of epistaxis

Answer 1

• Originate from Kiesselbach’s plexus, also known as Little’s area (area most affected by little fingers) - area of mucosa at the front of the nasal cavity that contains a lot of blood vessels
• Bleeding is usually unilateral
• Causes include:
  
  • Nose picking
  • Colds
  • Vigorous nose blowing
  • Trauma
  • Changes in weather
• Important to ask about anticoagulation, antithrombotics, bleeding disorders, cardiac history, hereditary haemorrhagic telangectasia, malignancy and previous surgery
• Drug Hx should also include nasal substances (include illicit)

Question 2

Management of epistaxis

Answer 2

• Most resolve without assistance
• Advise patients to sit up and tilt head forwards (stops blood flowing into airway), squeese soft part of nostrils together for 10-15 minutes, spit out any blood in mouth
• If severe can use nasal packing (nasal tampons, inflatable packs) and nasal cautery (silvert nitrate stick)
• Naseptin (chlorhexidine and neomycin) for prophylaxis but is contraindicated in peanut or soya allergy
• Can use surgical treatment (ligation of arteries), interventional radiology (arterial embolisation) and TXA in more severe or unresolving cases