Epistaxis

Question 1

Epistaxis Haemorrhage Types

Answer 1

• Anterior: source of bleeding visible in 95% of cases, usually from septum, usually Little’s area where Kiesselbach’s plexus forms
• Posterior haemorrhage: emanates from deeper structures and is more common in the elderly, bleeds usually more profuse and greater risk of airway compromise

Question 2

Epistaxis Aetiology

Answer 2

• Majority caused by simple trauma
• Platelet disorders e.g. thrombocytopenia, ITP
• Medications
• Malignancy
• Cocaine

Question 3

Epistaxis Presentation

Answer 3

• In anterior, out of nose, one nostril
• In posterior, into throat or both nostrils
• Note previous surgeries, medications and FHx
• Nasopharyngeal tumour may present with pain

Question 4

Epistaxis Investigations

Answer 4

• Usually unnecessary
• Bloods if severe or recurrent
• Refer if suspicion of malignancy

Question 5

Epistaxis Management

Answer 5

• A-E
• Sit upright, lean forwards, squeeze bottom part of nose
• Inspect nose after bleeding stops
• Cautery if you can see a vessel
• Never cauterise both sides of the septum in the same session