Presentation: Epistaxis Flashcards
What is epistaxis?
Epistaxis, or nose bleeds, is split into anterior and posterior bleeds. Anterior bleeds often have a visible source and occur due to an insult to Kiesselbach’s plexus, while posterior bleeds are more profuse and originate from deeper structures.
Who is more likely to experience posterior haemorrhages?
Posterior haemorrhages occur more frequently in older patients and confer a higher risk of aspiration and airway compromise.
What are common causes of epistaxis?
Common causes include nose picking, nose blowing, trauma, foreign bodies, bleeding disorders, immune thrombocytopenia, Waldenstrom’s macroglobulinaemia, juvenile angiofibroma, cocaine use, hereditary haemorrhagic telangiectasia, and granulomatosis with polyangiitis.
What should be done if a patient is haemodynamically stable with epistaxis?
Control bleeding with first aid measures: ask the patient to sit forward with their mouth open, pinch the soft area of the nose for at least 20 minutes, and breathe through their mouth.
What topical antiseptic can be used after first aid measures for epistaxis?
Consider using Naseptin (chlorhexidine and neomycin) to reduce crusting and the risk of vestibulitis, unless the patient has allergies to peanut, soy, or neomycin. Mupirocin is a viable alternative.
When should a patient with epistaxis be admitted for follow-up care?
Admission may be considered if there is a comorbidity, an underlying cause is suspected, or if the patient is under 2 years old.
What self-care advice should be given to patients after an epistaxis episode?
Patients should avoid blowing or picking the nose, heavy lifting, exercise, lying flat, drinking alcohol, or hot drinks to reduce the risk of re-bleeding.
What should be done if bleeding does not stop after 10-15 minutes of pressure?
Consider cautery or packing. Cautery should be used if the source is visible and tolerated.
How should cautery be performed for epistaxis?
Use a topical local anaesthetic spray, wait 3-4 minutes, identify the bleeding point, and apply silver nitrate stick for 3-10 seconds until it becomes grey-white.
What is the procedure for nasal packing in epistaxis?
Anaesthetise with a local anaesthetic spray, pack the nose while the patient is sitting forward, and examine for continuing bleeding.
When should patients be admitted to the emergency department for epistaxis?
Patients who are haemodynamically unstable, have a bleed from an unknown or posterior source, or have profuse bleeding should be admitted.
What may be required for epistaxis that has failed all emergency management?
Sphenopalatine ligation in theatre may be required.
