ENT- Epistaxis

Question 1

What percent of epistaxis cases are due to an anterior bleed vs a posterior bleed?

Answer 1

Anterior bleed (from Kiesselbach’s plexus)- 95%

Posterior bleed- 5%

***DONT WANT TO MISS POSTERIOR BLEED- CAN BE FATAL****

Question 2

Etiology of epistaxis

Answer 2

1. Nasal trauma (ex: picking nose)
2. Mucosal dryness/irritation
3. Mucosal hyperemia
4. Foreign body / neoplasm
5. Intranasal drug use
6. Alcohol
7. Anticoagulation therapy
8. Blood disorders
9. Atherosclerotic disease
10. Hereditary hemorrhagic telangiectasia
11. ?hypertension

*Nasal glucocorticoids can also caus epistaxis

Question 3

What history questions should be asked for epistaxis?

Answer 3

–Explore possible causes

–Timing, frequency, severity

Question 4

What is important to note on examination for epistaxis?

Answer 4

–Vitals, mental status, airway

–Nose: may need to pretreat with anesthetic or vasoconstrictor; try to identify source

Question 5

What labs might need to be drawn on a patient presenting with epistaxis?

Answer 5

–PT/INR – only anticoagulated patients

–Hematocrit, type and crossmatch

Question 6

What are possible treatments for epistaxis?

Answer 6

1. Conservative measures
2. Cautery
3. Nasal packing

Question 7

Epistaxis treatment- conservative measures

Answer 7

• Occlusion, continuous x 10-15 minutes
• Lean forward to prevent swallowing blood
• Cold compress to bridge of nose

Question 8

Epistaxis treatment options- cautery

Answer 8

Can use silver nitrate or electrical

Question 9

What are different methods of nasal packing for treatment of epistaxis?

Answer 9

• Nasal tampon (concern for TSS)
• Gauze packing
• Nasal balloon catheter

Question 10

Overview of epistaxis management

Answer 10

Question 11

What to do with a patient who has epistaxis and has persistent bleeding

Answer 11

1. Contralateral packing
2. ENT consultation
3. Posterior bleed- emergency, likely admission

Question 12

Epistaxis- after bleeding is controlled

Answer 12

–Avoid straining or vigorous exercise

–Apply nasal saline to packing

–Avoid hot or spicy food, tobacco (vasodilation)

–Avoid nasal trauma

–Lubrication (petroleum jelly or bacitracin ointment)

–Increase home humidity

–+/- antibiotics for TSS prophylaxis (if doing nasal tampon)