Epistaxis (or a more commonly known as nosebleeding) is the common occurrence of hemorrhage from the nose, usually noticed when the blood drains out through the nostrils. There are two types: anterior (the most common), and posterior (less common, more likely to require medical attention). Patient with epistaxis is in state of anxiety, frightened and apprehensive and in need of reassurance.
- Trauma & nose picking (commonest).
- Nasal and sinus infection.
- Neoplasms of nose and sinuses.
1- Hypertension (commonest).
2- Bleeding disorder.
3- Hepatic disorder.
4- Renal disorder.
5- Drugs, e.g., aspirin, NSAIDs, anticoagulants etc.
In majority of cases, no cause can be found.
Treatment of epistaxis depends upon certain factors, which are;
1- Amount of blood loss.
2- General condition of patient at presentation.
3- Age of patient.
4- Cause of epistaxis.
Minor Nose Bleed:
2- Cold sponging of nose and face.
3- Nose pinching.
4- Placing cotton plug soaked in Xylocaine 4 % with adrenaline for 5-10 min. (if patient is not hypertensive).
Active Anterior Epistaxis
1- Identify bleeding points and cauterize them with chemical (silver-nitrate 20%) or electric diathermy.
2- If bleeding point is not identified, anterior nasal packing soaked with polyfax skin ointment & liquid paraffin or BIPP (Bismuth iodoform paraffin paste). Admit the patient and INFORM THE CONSULTANT.
3- Set up & maintain I/V line and take blood samples for Hb, Blood for Grouping & cross-matching if required.
4- Monitor Vital Signs: Pulse, BP, respiratory rate, temperature.
5- Assess amount of blood loss by clinical signs & history. While awaiting blood transfusion, transfuse ringers lactate.
If Bleeding Not Controlled By Above Measures;
1- Posterior nasal packing.
2- Consider vessel ligation (Internal maxillary, external carotid, anterior ethmoidal arteries.
3- Embolization of bleeding vessels & discuss with ENT consultant.
If found, the cause of epistaxis should be treated accordingly