Epistaxis

Question 1

What causes anterior epistaxis?

Answer 1

Insult to network of capillaries that form Kiesselbach’s plexus, visible source of bleeding.

Question 2

What are the causes of epistaxis?

Answer 2

1. Trauma - nose picking, foreign body, nose blowing
2. Thrombocytopenia, leukaemia, immune thrombocytopenia purpura
3. Cocaine use (nasal septum atrophy)
4. Granulomatosis with polyangiitis

Question 3

What is the management of epistaxis if the patient is haemodynamically stable?

Answer 3

1. Sit with torso forward and breathe through mouth.
2. Pinch soft area of nose firmly and consistently for 15 mins.
3. If bleeding does not stop after 15 mins, consider cautery or packing.
4. Establish IV access

Question 4

What is cautery and why is it used?

Answer 4

1. Silver nitrate cauterises bleeding (2 secs at a time, use local anaesthetic spray, blow out nasal clots)
2. Only if source of bleed is visible

Question 5

When is nasal packing used and what are the steps?

Answer 5

1. If bleeding point cannot be visualised.
2. Apply local anaesthetic, insert anterior nasal pack parallel to hard palate, remove after 24 hrs, can pack other nostril.

Question 6

When do you use posterior packing in epistaxis?

Answer 6

If anterior packing has failed.

Question 7

What will be done after ENT referral for epistaxis where posterior packing has failed?

Answer 7

1. Surgical examination under GA.
2. Arterial ligation of sphenopalatine artery (internal maxillary branch)
3. Embolisation of internal maxillary/facial artery

Question 8

What is embolisation of the internal maxillary/facial artery used for and what is the major complication?

Answer 8

1. Epistaxis where posterior packing has failed

2. Stroke