The document discusses epistaxis (nosebleeds), including common causes, sites of bleeding, and management approaches. The two most common causes are idiopathy and trauma, with 90% of bleeds occurring from Little's area in the nose. Emergency management involves assessing the patient, monitoring vitals, resuscitation if needed, locating the bleeding site, and cauterization. Nasal packing may be used but is avoided if possible due to further trauma. Underlying causes are also evaluated and treated.

1. MR B MABUMBA
BSC CM (UNZASOM)
DIP CM (UNZASOM)

2. Objectives:
To understand;
1. The common cause of epistaxis
2. The common sites for epistaxis
3. Both emergency and long term management
of epistaxis

3.  Epistaxis is hemorrhage (bleeding) from the
nose
 It equally affects all age groups and sex
 Anterior epistaxis is more common in the
child or young adult
 Posterior nasal bleeding is more often seen in
older adults
 The incidence is more common in winter
when URTI are more frequent

4.  Two most common cause are idiopathy & trauma
 90% of nasal bleed occur from Little’s area, where
there is rich anastomotic supply formed by end
arteries (Kiesselbachs plexus). Posteriorly it
occurs from woodruffs area (veinous plexus)
Local Causes:
Trauma-external trauma to the nose (accidental),
repeated nose picking (intentional), surgical
trauma (iatrogenic), foreign body in the nose
 Inflammatory- due to infection, allergic disorders

5.  Physiological- violent exertion or excitement,
extremes of heat & cold, extreme alteration
of pressure
 Anatomical & structural deformities
 Intra nasal tumors
Systemic causes:
 Hypertension, bleeding diathesis, leukemia,
anemia, uremia, nephritis, liver cirrhosis,
vitamin K deficiency, toxic agents, drugs
(anticoagulant), hereditary hemorrhagic
telangiectasia (Osler Weber Rendu)

6.  Assess general condition of the patient
 Monitor the vitals
 If necessary start resuscitation- IVF/BT
 If patient bleeding, clean the nose & pinch it for
about 10 min. once bleeding stops, the nose is
examined & site of bleed located.
 Cauterization; by electric, chemical or thermal
 Nasal packing; every attempt should be made to
control bleeding without the pack, as this causes
further trauma to the nasal mucosa, is
troublesome for

7. patient and delays recovery
 A lubricated pack should be used and the pack
should be tight starting from the floor
 Pack should be removed 24-48 hrs
 After the pack examine & cauterize bleeding
points
 Posterior nasal packing should be done under
anesthesia. Rubber catheters are passed from the
nose to the oropharynx
 Adjuvant therapy include bed rest and
haemostatic preparations such as vitamin C, K &
calcium prep

8.  Full blood count, clotting screen
Note: attention should be paid to the
underlying cause & treatment accordingly
given