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
