Epistaxis resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Synonyms and keywords:
Overview
Epistaxis also known as noes bleeding, is a terminology name for bleeding of nose vessels that drains out from nostril (most often) and/or nasopharynx. Epistaxis is often stop easily but sometimes it's an ENT emergency which can be critical if appropriate action does not occur. Kiesselbach's plexus is the source of most epistaxis.
Causes
Base on the cause and severity of Epistaxis it can be life threatening.
Life Threatening Causes
Life-threatening causes of epistaxis include conditions that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Local trauma
- Acute sinusitis
- Allergic rhinitis
- Anticoagulation
- Aspirin
- Chronic rhinitis
- Chronic sinusitis
- Cocaine
- Common cold
- Foreign bodies
- Nose-picking
- Neoplasia
Diagnosis
Shown below is an algorithm summarizing the diagnosis of Epistaxis according the the [...] guidelines.
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Statement Action Strength
1:The patients needs prompt action
Prompt management At the time of initial contact, the clinician should distinguish the nosebleed patient who requires prompt management from the patient who does not.
Recommendation
2:
Nasal compression The clinician should treatactivebleedingforpatientsinneedofpromptmanagementwithfirmsustainedcompressionto thelowerthirdofthenose,withorwithouttheassistanceofthepatientorcaregiver,for5minutesorlonger.
Recommendation
3a:NasalpackingForpatientsinwhombleedingprecludesidentificationofableedingsitedespitenasalcompression,theclinicianshould treatongoingactivebleedingwithnasalpacking.
Recommendation
3b:Nasalpackinginpatientswith suspectedincreasedbleedingrisk
Theclinicianshoulduseresorbablepackingforpatientswithasuspectedbleedingdisorderorforpatientswhoareusing anticoagulationorantiplateletmedications.
Recommendation
4:NasalpackingeducationTheclinicianshouldeducatethepatientwhoundergoesnasalpackingaboutthetypeofpackingplaced,timingofandplan forremovalofpacking(ifnotresorbable),postprocedurecare,andanysignsorsymptomsthatwouldwarrantprompt reassessment.
Recommendation
5:RiskfactorsTheclinicianshoulddocumentfactorsthatincreasethefrequencyorseverityofbleedingforanypatientwithanosebleed, includingpersonalorfamilyhistoryofbleedingdisorders,useofanticoagulantorantiplateletmedications,orintranasal druguse.
Recommendation
6:Anteriorrhinoscopytoidentify locationofbleeding
Theclinicianshouldperformanteriorrhinoscopytoidentifyasourceofbleedingafterremovalofanybloodclot(if present)forpatientswithnosebleeds.
Recommendation
7a:Examinationusingnasal endoscopy
Theclinicianshouldperform,orshouldrefertoaclinicianwhocanperform,nasalendoscopytoidentifythesiteof bleedingandguidefurthermanagementinpatientswithrecurrentnasalbleeding,despitepriortreatmentwithpackingor cautery,orwithrecurrentunilateralnasalbleeding.
Recommendation
7b:Examinationofnasalcavityand nasopharynxusingnasal endoscopy
Theclinicianmayperform,ormayrefertoaclinicianwhocanperform,nasalendoscopytoexaminethenasalcavityand nasopharynxinpatientswithepistaxisthatisdifficulttocontrolorwhenthereisconcernforunrecognizedpathology contributingtoepistaxis.
Option
8:Appropriateinterventionsfor identifiedbleedingsite
Theclinicianshouldtreatpatientswithanidentifiedsiteofbleedingwithanappropriateintervention,whichmayinclude oneormoreofthefollowing:topicalvasoconstrictors,nasalcautery,andmoisturizingorlubricatingagents.
Recommendation
9:NasalcauteryWhennasalcauteryischosenfortreatment,theclinicianshouldanesthetizethebleedingsiteandrestrictapplicationof cauteryonlytotheactiveorsuspectedsite(s)ofbleeding.
Recommendation
10:Ligationand/orembolizationfor persistentnosebleeds
Theclinicianshouldevaluate,orrefertoaclinicianwhocanevaluate,candidacyforsurgicalarterialligationorendovascular embolizationforpatientswithpersistentorrecurrentbleedingnotcontrolledbypackingornasalcauterization.
Recommendation
11:Managementofpatientsusing anticoagulationandantiplatelet medications
Intheabsenceoflife-threateningbleeding,theclinicianshouldinitiatefirst-linetreatmentspriortotransfusion,reversalof anticoagulation,orwithdrawalofanticoagulation/antiplateletmedicationsforpatientsusingthesemedications.
Recommendation
12:Hereditaryhemorrhagic telangiectasia(HHT)identification
Theclinicianshouldassess,orrefertoaspecialistwhocanassess,thepresenceofnasaltelangiectasiasand/ororalmucosal telangiectasiasinpatientswhohaveahistoryofrecurrentbilateralnosebleedsorafamilyhistoryofrecurrentnosebleeds todiagnosehereditaryhemorrhagictelangiectasiasyndrome.
Recommendation
13:Patienteducationand prevention
Theclinicianshouldeducatepatientswithnosebleedsandtheircaregiversaboutpreventivemeasuresfornosebleeds,home treatmentfornosebleeds,andindicationstoseekadditionalmedicalcare.
Recommendation
14:NosebleedoutcomesTheclinicianordesigneeshoulddocumenttheoutcomeofinterventionwithin30daysordocumenttransitionofcarein patientswhohadanosebleedtreatedwithnonresorbablepacking,surgery,orarterialligation/embolization.
Recommendation
| Patient with epistaxis | |||||||||||||||||||||||||||||||||||||||||||||||||
| Does the patient need immediate action? | |||||||||||||||||||||||||||||||||||||||||||||||||
| Yes→Volume replacement,airway check, Needs for emergency departement | No | ||||||||||||||||||||||||||||||||||||||||||||||||
| Active Bleeding? | |||||||||||||||||||||||||||||||||||||||||||||||||
| Yes→Nasal compression for≥5 min | |||||||||||||||||||||||||||||||||||||||||||||||||
| E01 | E02 | NO→Rhinoscopy to identify location of bleeding | |||||||||||||||||||||||||||||||||||||||||||||||
| F01 | F02 | ||||||||||||||||||||||||||||||||||||||||||||||||
| G01 | G02 | G03 | G04 | ||||||||||||||||||||||||||||||||||||||||||||||
| H01 | H02 | H03 | |||||||||||||||||||||||||||||||||||||||||||||||
| I01 | I02 | ||||||||||||||||||||||||||||||||||||||||||||||||
| J01 | J02 | J03 | J04 | ||||||||||||||||||||||||||||||||||||||||||||||
| K01 | K02 | ||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.