Treat and Refer - Epistaxis

Question 1

Approximately 5% of epistaxis originate from the posterior area of the nose. Why is this significant?

Answer 1

Typically unable to be controlled with manual pressure.

Question 2

Posterior or anterior epistaxis unable to be controlled with manual pressure will require further medical management, which may include?

Answer 2

Topical vasoconstrictors, cauterisation, nasal packing and/or surgery.

Question 3

List some examples of anticoagulants that contraindicate a pt for TnR Epistaxis.

Answer 3

Warfarin, dabigatran, rivaroxaban, apixaban.

Question 4

List some bleeding disorders that contraindicate a pt for TnR Epistaxis.

Answer 4

Haemophilia, Von Willebrand.

Question 5

What is the initial management of an epistaxis?

Answer 5

Position pt upright with forward neck flexion.
Ask pt to continuously pinch and hold soft part of nose for 15mins.
Apply cold cloth/compress to forehead.
Encourage pt to breathe through their mouth and spit out any blood collecting in mouth.

Question 6

Pts should avoid blowing or picking their nose for ____ hours after cessation of an epistaxis?

Answer 6

12.

Question 7

What are the 3 contraindications to Treat and Referring an epistaxis?

Answer 7

1. Unable to control bleeding after 15mins
2. Recent Hx head/facial trauma
3. Pt on anticoagulants or has Hx bleeding disorders

Question 8

What are the 2 options for Treating and Referring an epistaxis, if not contraindicated?

Answer 8

1. Provide info sheet, confirm pt understands information

2. Refer pt to a PCP within 24hrs

Question 9

When should an epistaxis be referred to a PCP within 24hrs?

Answer 9

1. Very minor or intermittent bleeding remains
2. Pt has experienced recurrent epistaxis episodes
3. Pt is on antiplatelet therapy
4. BP remains high after resolution of epistaxis