Nosebleeds

Question 1

Which area does epistaxis normally occur in?

Answer 1

Kiesselbach’s plexus, located in Little’s area

Question 2

Triggers of nosebleeds

Answer 2

Nose picking

Colds

Sinusitis

Vigorous nose-blowing

Trauma

Changes in the weather

Coagulation disorders (e.g., thrombocytopenia or Von Willebrand disease)

Anticoagulant medication (e.g., aspirin, DOACs or warfarin)

Snorting cocaine

Tumours (e.g., squamous cell carcinoma)

Question 3

Presentation of epistaxis

Answer 3

Bleeding from the nose - often unilateral

May present with blood in vomit if blood swallowed

Question 4

Implications of bilateral bleeding

Answer 4

May indicate bleeding posteriorly in the nose

Higher risk of aspiration of blood

Question 5

Management of epistaxis

Answer 5

Most resolve by themselves

Question 6

Advice for epistaxis

Answer 6

Sit up and tilt the head forwards

Squeeze the soft part of the nostrils together for 10 – 15 minutes

Spit out any blood in the mouth, rather than swallowing

Question 7

Severe epistaxis

Answer 7

Bleeding for more than 10 - 15 minutes

Bilateral bleeding

Haemodynamically unstable

Question 8

Management of severe epistaxis

Answer 8

Nasal packing using nasal tampons or inflatable packs

Nasal cautery using silver nitrate sticks

Question 9

Recurrent epistaxis

Answer 9

Cautery

Investigate for underlying pathology such as bleeding conditions

Question 10

After treatment for epistaxis

Answer 10

Naseptin nasal cream (chlorhexidine and neomycin) qds for 10 days to reduce any crusting, inflammation and infection.

Question 11

Contraindications for naseptin

Answer 11

Peanut or soya allergy