Epistaxis

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Background

Epistaxis is another name for what is commonly known as nose-bleeds

It is an acute hemorrhage from the nostril, nasal cavity, or nasopharynx

Common ED complaint, but 90% of patients can be treated with

Occurs up to 60% of general population, but rarely leads to massive bleeding and death

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Where does it happen?

• Two sources

•Anterior (more common)

•Posterior (typically common among old patients)

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Causes

Many different causes – locally, systemically, and environmentally

Environmental causes include allergens and humidity

Can also be idiopathtic

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Common local causes

Chronic sinusitisEpistaxis digitorum (nose picking)Foreign bodiesIntranasal neoplasm or polypsIrritants Medications RhinitisTrauma Brought to you by

Common systemic factors

HemophiliaHypertensionLeukemiaLiver disease (e.g., cirrhosis)MedicationsPlatelet dysfunction/Thrombocytopenia

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Treatment

Flow of blood normally stops when the blood clots

To encourage blood clotting- Pinch the upper fleshy part of nose- Do so for 5-20 minutes- Tilt head forward can decrease the chance of

nausea and airway obstruction from swallowing blood

- Vasoconstrictive agents can also be used- Other products available to promote coagulation

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Packing when simple treatment fails for anterior bleeding

•Anterior nasal cavity is packed from posterior to anterior with ribbon gauze that has petroleum jelly

•Bayonet forceps and a nasal speculum can be used to approximate accordion folding of gauze

•Each layer should be pressed down firmly before next layer is added

Bayonet forceps

Nasal speculum

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Packing for posterior epitasis

• Done by Otolaryngologist

•A catheter is passed through the nostril and through the nasopharynx and out the mouth

•A gauze pack is at the end of the catheter

•The gauze pack is guide through the mouth and into the posterior nasal cavity Brought to you by

Other treatments

Balloon packingCauterization of blood vesselLaser therapyEmbolization

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Prevention

Cooler houseVaporizer to

return humidity and moisture to the air

Nasal saline spray and water soluable jelly (especially for winter months)

Avoid picking the nose or blowing the nose too vigorously.

Do not strain to bend down or lift anything too heavy.

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