Epistaxis

Question 1

What is epistaxis?

Answer 1

Nosebleeds

Question 2

Where does the bleeding originate from?

Answer 2

Kiesselback’s plexus which is located in Little’s area - an area of the nasal mucosa which has a lot of vessels

Question 3

What triggers nosebleeds?

Answer 3

• Nose picking
• Colds
• Sinusitis
• Trauma
• Coagulation disorders
• Anticoagulant medication
• Snorting cocaine

Question 4

How does epistaxis present?

Answer 4

Unilateral bleeding
Bilateral bleeding would suggest bleeding posterior in the nose -> greater risk of aspiration

Question 5

How is epistaxis managed?

Answer 5

• Usually self resolves
• Recurrent may need investigation for clotting disorders
• Patients should be advised to sit up and tilt head forwards and squeeze soft part of nostrils for 10-15 minutes

Question 6

How is epistaxis managed in hospital setting if not settling?

Answer 6

• Nasal packing with nasal tampons/inflatable packs
• Nasal cautery using silver nitrate sticks

Question 7

What can be prescribed after a nosebleed to reduce crusting/inflammation/infection?

Answer 7

Naseptin nasal cream