Epistaxis

• What does epistaxis refer to?


  Nosebleeds
• How do the severities of epistaxis vary?


  They range significantly from mild to life-threatening
• What is the initial management step for epistaxis?


  Direct pressure on the cartilaginous part of the nose
• What are some contributing factors to epistaxis?


  Trauma, inflammation, drug use, recent surgery, tumors, and bleeding diatheses
• Where does bleeding from epistaxis usually originate?


  Anterior nasal septum
• What percentage of epistaxis cases are posterior?


  About 10%
• What are the common causes of epistaxis?

  • Trauma (e.g. nose-picking, blunt trauma)
  • Oxygen via nasal cannulae
  • Recent ENT or maxillofacial surgery
  • Tumours (malignant or benign)
  • Inflammation (e.g. rhinosinusitis)
  • Alcohol excess
  • Illicit drug use (e.g. cocaine)
  • Medications (e.g. nasal steroids)
  • Vasculitides
  • Bleeding diatheses
  • Environmental factors
• What is the major symptom of epistaxis?


  Nasal bleeding
• What might bleeding down the throat indicate?

  Possible posterior epistaxis
• What signs may indicate significant blood loss in epistaxis?


  Tachycardia, pallor, syncope
• Are investigations usually required for most cases of epistaxis?


  No, most cases do not require investigations
• What tests should be done if bleeding is significant?

  Venous blood gas, FBC, clotting screen, group and save
• What are the steps in the management of epistaxis?


  1. Direct compression
  2. Patient sits forward, pinches nose for 10-15 minutes
  3. Sucking ice cubes or applying ice pack
  4. Topical antiseptic may be prescribed
  5. Cautery if bleeding point is visible
  6. Nasal packing if bleeding continues
  7. Surgical approach or embolisation if necessary
  8. Tranexamic acid for severe bleeding
  9. Manage anticoagulants and resuscitation if needed
• What is the first step in the management of epistaxis?


  Direct compression
• How long should direct compression be applied for epistaxis?


  10-15 minutes
• What should be done if direct compression does not resolve the epistaxis?


  Cautery may be performed
• What is the purpose of cautery in epistaxis management?


  To temporarily halt bleeding at a visible bleeding point
• What are common devices used for nasal packing?

  Nasal tampons and inflatable packs
• How long should nasal packing be left in place?


  24-48 hours
• What should be given to all patients with severe bleeding?

  Tranexamic acid
• What are the potential complications of epistaxis management?


  • Anaemia
  • Recurrent epistaxis
  • Hypovolaemia
  • Aspiration of blood
  • Septal perforation from cautery
  • Sinusitis, septal haematoma, or pressure necrosis from packing