Epistaxis

Question 1

What is epistaxis?

Answer 1

Nosebleeds

Question 2

What is the most likely area to bleed in epistaxis?

Answer 2

Anterior 1/3 of the nasal cavity known as little’s area or the kiesselbach plexus

Question 3

What are the causes of epistaxis?

Answer 3

• Idiopathic mostly
• Trauma
• Older age
• Anticoagulation meds
• Dry hot weather
• rapid alterations of temperature

Question 4

What is the first aid management

Answer 4

• Sit with head forward
• Pinch nares firmly, closing nostrils
• Hold nose for 20mins without releasing
• Ice
• Spit out any blood

Question 5

What is the management if excessive bleeding?

Answer 5

• IV access
• Bloods: FBC, U&E, Clotting, G&S
• Massive haemorrhage protocol

Question 6

What is the management of epistaxis?

Answer 6

Second line measures:
1st: Nasal cautery -silver nitrate, stick/electrical (if visible bleed

2nd. Nasal packing -nasal tampon, balloons
3. Surgery -end artery ligation (usually sphenopalatine) gold standard of treatment
4. Embolization if life threatening

Question 7

What points have to be considered when managing epistaxis?

Answer 7

• Consider risk/benefit of stopping anti-coag

* Control BP

Question 8

When does a patient need admitting for epistaxis?

Answer 8

• Anyone who has had nasal packing
• Keep 24hrs for observations
• Home with anti-septic cream

Question 9

After a patient has been admitted due a nosebleed, what do they require when going home?

Answer 9

*Home with anti-septic cream
*Advice:
>Don’t blow, pick/traumatise nose
>avoid strenuous activity
>apply antiseptic cream BD 2 weeks
>First aid measures if re-bleed