Epistaxis ****

Question 1

In what area does it usually occur?

Answer 1

Kiesselbach’s plexus

Question 2

Causes:

Same for quite a few things
Trauma or anatomical
Tumour - one is in teenage boys
Coagulopathy

What may exacerbate it?

Answer 2

Idiopathic

Nose-picking
Assault
Fall
Polyps 
Nasal surgery 

SCC
Juvenile angiofibroma

Warfarin
Leukaemia
Von Williebrand Disease
Haemophillia

HTN

Question 3

Presentation of anterior bleeds

Presentation of posterior bleeds

What may it be associated with?

Answer 3

Bloods runs out of the nostrils

Bloods runs down the throat

Septal perforation or nasal fracture

Question 4

When are investigations needed?

What investigations are needed?

Answer 4

Severe
Recurrent

Bloods - FBC, coag, LFT’s

Question 5

Management with acute nose bleed:

Step 1 - evaluate for severe haemorrhage and attempt conservative measures

What is Trotters method?

Answer 5

ABC assessment if suspected hypovolaemia

Pinch lower nostrils
Sit up
Lean forward
DO for 10 mins

Question 6

Management with acute nose bleed:

Step 2 - topical therapy

Answer 6

Vasoconstriction with adrenaline via spray or soaked gauze +/- lidocaine

Oxymetazoline sometimes used first before external compression

Antifibrinolysis with tranexamic acid via soaked gauze if adrenaline is unsuccessful

Question 7

Management with acute nose bleed:

Step 3 - Cautery or packing

Answer 7

Look for bleeding vessel and cauterise

Lidocaine should be used first

Silver nitrate sticks used first then a diathermy

Question 8

Management with acute nose bleed:

Further invasive options

Answer 8

Foley catheter
Surgical ligation of artery
Embolisation via interventional radiology

Question 9

Management with acute nose bleed:

How long should you wait before discharging someone?

What should be avoided for the next 24 hours?

Answer 9

30 mins

Blowing or picking nose (if sneezing, keep your mouth open)
Heavy lifting or straining
Lying flat - BP
Alcohol or hot drinks should be avoided