Overview
Epistaxis, or recurrent bleeding of the nose, is a frequent otolaryngology emergency characterized by bleeding from the nasal cavity. It can originate from anterior sites like the Kiesselbach plexus or posterior sites involving deeper arterial branches 2.Diagnosis
Airway, Breathing, Circulation (ABCs) Assessment: Essential initial step to ensure no airway compromise 2.
Identification of Bleeding Source: Direct visualization or imaging may be required for posterior bleeds 2.
Risk Factor Evaluation: Consider local trauma, foreign bodies, substance abuse, bleeding disorders, and neoplasms 27.
Demographic Factors: More common in males and bimodal age distribution (<10 years and >70 years) 3.Management
First-Line Treatments:
- Direct Pressure: Immediate application to control bleeding 2.
- Topical Vasoconstrictors: Such as oxymetazoline to reduce blood flow 2.
- Cautery: Useful for anterior bleeds to achieve hemostasis 2.
Adjunctive Treatments:
- Tranexamic Acid: Anti-fibrinolytic agent to reduce bleeding 2.
- Nasal Packing: Absorbable or nonabsorbable packing for persistent bleeds 12.
- Endoscopic Techniques: Targeting bleeding points with endoscopic equipment 6.
- Interventional Radiology: For posterior bleeds, reducing need for embolization 6.Special Populations
Elderly: Higher incidence noted, with bimodal peak in older adults >70 years 3.
Comorbidities: Posterior epistaxis or significant comorbidities may necessitate hospitalization 2.Key Recommendations
Assess ABCs before addressing bleeding source (Evidence: Strong 2).
Consider ENT consultation for advanced management or persistent bleeding (Evidence: Moderate 1).
Utilize endoscopic techniques and interventional radiology for posterior epistaxis to reduce hospital stay and transfusion needs (Evidence: Moderate 6).
Educate high-risk patients on first-aid measures for epistaxis (Evidence: Expert opinion 6).
Evaluate for underlying causes such as bleeding disorders and local anatomical abnormalities in habitual nose-bleeders (Evidence: Moderate 7).References
1 Jacobs D, Wang VJ, Chao JR, Manes RP, Lee YH. Treatment, Management, and Otolaryngology Consultation for Epistaxis in the Emergency Room: An Institutional Experience. American journal of rhinology & allergy 2024. link
2 Krulewitz NA, Fix ML. Epistaxis. Emergency medicine clinics of North America 2019. link
3 Reis LR, Correia F, Castelhano L, Escada P. Epidemiology of epistaxis in the emergency department of a southern European tertiary care hospital. Acta otorrinolaringologica espanola 2018. link
4 Kurien G, Biron VL, Campbell C, Cote DW, Ansari K. Can a multisensory teaching approach impart the necessary knowledge, skills, and confidence in final year medical students to manage epistaxis?. Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 2013. link
5 Melia L, McGarry G. Epistaxis in adults: a clinical review. British journal of hospital medicine (London, England : 2005) 2008. link
6 Tan LK, Calhoun KH. Epistaxis. The Medical clinics of North America 1999. link70086-9)
7 Beran M, Petruson B. Changes in the nasal mucosa of habitual nose-bleeders. Acta oto-laryngologica 1986. link