Epistaxis Management Flashcards
What are the key aspects to focus on in a history of a patient with epistaxis?
Haemorrhage details
Drugs history
Key aspects include side of bleed, quantity of blood, trigger/recent trauma, duration, posterior drip, previous epistaxis, recent infection, anticoagulation, and intranasal medications.
What serious differential diagnoses should be considered for unilateral epistaxis?
Nasopharyngeal carcinoma
* Unilateral bleeding
* Progressive hoarseness
* Dysphagia
* Hearing loss
* Significant smoking history
* Southeast asian descent
Juvenile nasal angiofibroma (Younger patients with unilateral epistaxis)
Granulomatosis with polyangiitis (Wegener’s):
* Saddle-shaped nose deformity
* Dyspnoea & haemoptysis
* Renal failure
What are the clinical features of granulomatosis with polyangiitis?
Saddle-shaped nose deformity
Dyspnoea
Haemoptysis
Renal failure
These features can help differentiate it from other causes of epistaxis.
What percentage of epistaxis cases are anterior and where do they commonly occur?
90% of bleeds are anterior, occur in Little’s area from Kiesselbach’s plexus
Posterior bleeds are more common in the elderly.
What is the bimodal age distribution for epistaxis?
<10 years and 45-65 years
This distribution indicates the age groups most affected by epistaxis.
What blood tests are indicated in the investigation of epistaxis?
FBC
Coagulation profile (aPTT, PT/INR)
Group and hold
These tests help assess the patient’s blood status and coagulation ability.
What is the first-line treatment for a mild case of epistaxis?
Nasal alae compression for 10 minutes and lean forward
Trotter’s method may be used, along with phenylephrine spray or adrenaline-soaked gauze.
What is the first-line treatment for an anterior bleed?
Cautery combined with local anaesthetic and topical vasoconstrictors
This includes chemical cautery and electrical cautery techniques.
What are the complications associated with nasal packing?
Pain
Toxic shock syndrome
Septal perforation
Adhesions
These complications need to be monitored during treatment.
What is the first-line treatment for posterior bleeds?
Nasal packing
Posterior bleeds usually require hospital admission due to associated risks.
What surgical management options are available for severe epistaxis?
Ligation
Angiographic embolisation
Surgical interventions are indicated for life-threatening haemorrhage or high risk of rebleeding.
What advice should be given upon discharge after treatment for epistaxis?
Use Naseptin or vaseline for the nose and avoid hot drinks
