Epistaxis Quick Guide

Types

Anterior (80-95%)

Little's area (Kiesselbach's plexus)

Posterior

Sphenopalatine artery branches

Assessment

  1. ABC first if active bleeding
  2. Identify bleeding point
  3. Check for underlying causes
  4. Assess blood loss

First Aid

  1. Lean forward
  2. Pinch soft nose 10-15 min
  3. Ice application

Cautery

  • For visible anterior bleeds
  • Local anesthetic first
  • Never both sides of septum

Packing

  • Failed cautery cases
  • Remove after 24-48h
  • Posterior bleeds → ENT

Red Flags

  • Children < 2 years
  • Possible NAI
  • High INR on warfarin
  • Tumor symptoms

Epistaxis Management

Epistaxis is bleeding from the nostril, nasal cavity or nasopharynx. Epistaxis may occur at any age but peaks in incidence occur in children < 10 years and adults > 45 years.

Anterior bleeds (80-95%)

Originate from Little's area on the anterior nasal septum (Kiesselbach's plexus).

Posterior bleeds

Originate from sphenopalatine artery branches. More common in elderly, more profuse, bilateral bleeding.

Causes

Local Causes

  • Trauma (nose-picking, fractures)
  • Inflammation (infection, allergies)
  • Topical drugs (cocaine, decongestants)
  • Vascular abnormalities
  • Tumors (benign or malignant)
  • Nasal oxygen therapy

Systemic Causes

  • Atherosclerosis
  • Increased venous pressure
  • Bleeding disorders
  • Anticoagulant medications
  • Alcohol consumption
  • Environmental factors

Complications

Of Nasal Bleeding:

  • Hypovolemia
  • Anemia
  • Aspiration
  • Death (rare)

Of Treatment:

  • Sinusitis (packing)
  • Septal perforation (cautery)
  • Toxic shock syndrome
  • Apneic episodes

Assessment

  1. Begin with ABC assessment if active bleeding
  2. Assess blood loss amount and duration
  3. Examine both nasal passages
  4. Identify bleeding point if possible
  5. Evaluate for underlying causes

Red Flags:

  • Children < 2 years (uncommon age)
  • Possible non-accidental injury
  • Symptoms suggesting tumor
  • Bleeding disorders
  • High INR on warfarin

Management

First Aid Measures:

  1. Lean forward, pinch soft nose for 10-15 min
  2. Ice application may help
  3. If bleeding stops, observe 15 min
  4. Consider topical antiseptic if recurrent

Nasal Cautery:

  • For identifiable anterior bleeding points
  • Use local anesthetic with vasoconstrictor
  • Silver nitrate or electrocautery for 3-10 sec
  • Never cauterize both sides of septum
  • Topical TXA may be alternative in adults

Nasal Packing:

  • For failed cautery or no visible source
  • Various pack types available
  • Observe minimum 30 min after placement
  • Remove after 24-48 hours
  • Posterior bleeds require ENT referral

Patient Advice

Prevention of Rebleeding:

  • Avoid nose blowing/picking for 24h
  • No heavy lifting/strenuous exercise
  • Avoid lying flat
  • Avoid alcohol/hot drinks
  • Seek help if bleeding recurs