Epistaxis

Question 1

Where does bleeding usually originate in nosebleeds?

Answer 1

Kiesselbach’s plexus, located in Little’s area

Question 2

List three common aetiologies of nosebleeds.

Answer 2

• Nose picking
• Colds, sinusitis
• Vigorous nose-blowing

Question 3

Name two coagulation disorders that can cause nosebleeds.

Answer 3

• Thrombocytopenia
• Von Willebrand’s disease

Question 4

What are two substances that can increase the risk of nosebleeds?

Answer 4

• Anticoagulants
• Antiplatelets

Question 5

What might bilateral nostril bleeding indicate in epistaxis?

Answer 5

Posterior bleed, higher risk aspiration

Question 6

What does vomiting blood indicate in the context of nosebleeds?

Answer 6

Swallowing of blood

Question 7

What is the initial management advice for a nosebleed?

Answer 7

• Sit up and tilt head forwards
• Squeeze soft part of nostrils for 10-15 minutes
• Spit out any blood in the mouth

Question 8

When should secondary care management be considered for a nosebleed?

Answer 8

• Bleeding not stopped after 10-15 minutes
• Severe nosebleed
• Bleeding bilaterally from both nostrils
• Haemodynamically unstable

Question 9

What are two secondary care treatments for nosebleeds?

Answer 9

• Nasal packing (nasal tampons or inflatable packs)
• Nasal cautery (silver nitrate sticks)

Question 10

What is an option for post-epistaxis management?

Answer 10

Naseptin nasal cream.
Contains chlorhexidine and neomycin.
Applied 4x daily for 10 days.

Question 11

What is a contraindication for using naseptin nasal cream?

Answer 11

Peanut and soya allergy

Question 12

How to manage epistaxis that has not resolved with emergency treatment including packing +/- cautery?

Answer 12

Ligation of sphenopalatine artery in theatre