2. History
Proper management of epistaxis depends on careful history obtained from patient or his family.
Personal History
1.Age-
Children-Fever , idiopathic , trauma and foreign body
Adolescents-Trauma, dryness of nasal mucosa, nasopharyngeal angiofibroma
Elderly patients- Hypertension, or tumors
2.sex-
Males are more exposed to trauma and nasopharyngeal angiofibroma occur exclusively in males
3. 3.Residence-patients living in high altitude
4.Occupation-working in dusty atmospheres or chemical fumes
Present History
Specifics questions can can indicate whether the epistaxis is
A. Anterior epistaxis, or posterior, or diffuse
Anterior epistaxis-(indicates local pathology)
Causes- Idiopathic, Fever, Digital Trauma, F.B., Septal Perforations, Retrocolumellar Vein
4. Posterior epistaxis-
Causes-Nasopharyngeal lesions, superior or posterior part of nasal cavity lesions
Diffuse epistaxis-
Causes- Coagulation disorders, Hemorrhagic diathesis, Osler-Weber-Rendu disease
B. New or Recurrent
6. C. Spontaneous or induced by specific events
Causes-
1. Idiopathic
2. Fever
3. Tumors
D. Mild or severe
Mild-few drops of blood tinged sensation, short lived epistaxis, usually of capillary or venous origin
Severe-may be ass. With shock, usually seen in elderly, usually of arterial origin, usually U/L
7. E .Past history-
1. Family H/O- bleeding disorders
2. Drug intake- anticoagulants, antiplatelet aggregations, salicylates
3. Systemic disorders- HTN, chronic pulmonary disease, liver disease, renal disease
