Epistaxis
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Features
Bleeding from a unilateral anterior nasal cavity most common.
Management
- Most cases of anterior epistaxis may be successfully treated by direct pressure on the site by compression of the flares continuously for 15 minutes. Venous pressure is reduced in the sitting position, and slight leaning forwad lessens the swallowing of blood.
- Xynosine (xylometazoline) Nasal drops/spray 2 sprays in nostril scat
- When the bleeding does not readily subside,
- The nose should be examined, using good illumination and suction, in an attempt to locate the Needing site.
- If bleeding persists, anterior nasal packing of nose with ribbon gauze soaked in liquid paraffin and lidocaine (Lignocaine).
- When visible, the bleeding site may be cauterized with silver nitrate, diathermy, or electrocautery.
- About 5% of nasal bleeding originates in the posterior nasal cavity, commonly associated with atherosclerotic disease and hypertension. In such cases, it may be necessary to consult an otolaryngologist for a pack to occlude the choana before placing a pack anteriorly.
- In emergency settings, double balloon packs (Epistat) may facilitate rapid control of bleeding with little or no mucosal trauma. Because such packing is uncomfortable, bleeding may Persist and vasovagal syncope is possible, hospitalization for monitoring and stabilization is indicated. Posterior nasal packing is quite uncomfortable and may require an opioid analgesic for pain control.
- Surgical management of epistaxis, through ligation of the nasal arterial supply (internal maxillary artery and ethmoid arteries) is indicated when direct pressure and nasal packing fail. The most common approach to surgical treatment is endoscopic sphenopalatine artery ligation.
- After control of epistaxis, the patient is advised to avoid straining and vigorous exercise for several days. Nasal saline should be applied to the packing frequently to keep the packing moist. Avoidance of hot or spicy foods and tobacco is also advisable. Since they may cause nasal vasodilation