Epistaxis

Question 1

What is the name of the speculum used to examine the nasal cavities?

Answer 1

Thuddicum’s speculum

Question 2

What do we use to examine the nose?

Answer 2

Rigid or flexible nasoendoscope

Question 3

How do we approach a nose examination?

Answer 3

1. Inspect the external nose
2. Anterior rhinoscopy
3. Posterior rhinoscopy

Question 4

What are the 2 names that can be used to describe the plexus of vessels in the anterior nasal cavity?

Answer 4

1. Little’s Area

2. Kiesselbach’s plexus

Question 5

How do you treat a unilateral anterior epistaxis?

Answer 5

1. Silver nitrate cautery of the affected area (only ever one side at a time)
2. Naseptin ointment for 7-14 days (keeps the lining free of crusts) - Contains peanuts so always check for an allergy
3. Epistaxis advice = no blowing the nose for 7 days, do not clean the nose, avoid hot baths and showers, let food cool, no hot tea/coffee for 72 hours, no strenuous exercise for 7 days

Question 6

What should you warn patients who have had severe epistaxis to avoid?

Answer 6

• Hot drinks
• Very hot baths/showers
• Picking the nose
• Hot and spicy food

Question 7

When someone presents with a heavy and severe epistaxis, how will you manage the patient?

Answer 7

1. A-E assessment, make sure the patient is stable

2. Gain IV access - blood loss can be significant

Question 8

What is the stepwise management of epistaxis?

Answer 8

1. Cautery
2. Anterior pack or posterior depending on bleeding location
3. Artery ligation

Question 9

What can cause epistaxis?

Answer 9

1. Trauma (including digital trauma)
2. Hypertension
3. Individuals with a coagulopathy
4. Individuals on anticoagulant medication
5. Inflammation of the nasal mucosa
6. Sinonasal/postnasal space malignancy
7. Idiopathic
8. Iatrogenic