Epistaxis

Question 1

What does epistaxis refer to?

Answer 1

Bleeding from the nose

Usually originates from the anterior nasal septum; approximately 10% of cases are posterior.

Question 2

List some factors that may contribute to epistaxis.

Answer 2

• Trauma (nose-picking, blunt trauma)
• Oxygen via nasal cannulae
• Recent ENT or maxillofacial surgery
• Tumours (benign or malignant)
• Inflammation (rhinosinusitis, nasal polyps)
• Alcohol excess
• Illicit drug use (cocaine)
• Medications (nasal steroids)
• Vasculitides (e.g., granulomatosis with polyangiitis)
• Bleeding disorders (thrombocytopenia, Von Willebrand disease, haemophilia)
• Environmental factors (inhaled irritants, temperature, humidity)

These factors can lead to nasal bleeding.

Question 3

What is the major symptom of epistaxis?

Answer 3

Nasal bleeding

Other signs may include bleeding down the throat, bleeding from both nostrils, and signs of haemodynamic instability.

Question 4

True or false: Epistaxis can be a clear clinical diagnosis.

Answer 4

TRUE

However, swallowed blood may mimic conditions like haemoptysis or haematemesis.

Question 5

What investigations are typically required for nosebleeds?

Answer 5

• Basic observations for haemodynamic stability
• Venous blood gas and FBC for significant bleeding
• Clotting screen for coagulopathy
• Group and save or crossmatch if transfusion is needed
• LFTs for liver disorders

Most cases do not require investigations unless a serious cause is suspected.

Question 6

What is the management approach for patients with haemodynamic instability due to epistaxis?

Answer 6

Adopt an A-E approach

Urgent transfusion may be required; seek senior input early.

Question 7

What are the conservative measures for treating non-severe nosebleeds?

Answer 7

• Sit forward
• Breathe through the mouth
• Pinch the cartilaginous part of the nose for 10-15 minutes

A topical antiseptic may be prescribed to reduce crusting and rebleeding.

Question 8

What is nasal cautery used for in the treatment of epistaxis?

Answer 8

To halt bleeding by applying a local anaesthetic and then using silver nitrate or electrocautery

Only one side of the septum should be cauterised to avoid perforation.

Question 9

What is the purpose of nasal packing in epistaxis management?

Answer 9

To compress the bleeding area if a bleeding point cannot be visualised or bleeding continues

Common devices include nasal tampons or inflatable packs.

Question 10

What may be required in cases of posterior epistaxis?

Answer 10

Posterior packing, which may involve a Foley catheter

The balloon is inflated to compress the bleeding area.

Question 11

What medical approaches are used for severe bleeding in epistaxis?

Answer 11

• Tranexamic acid
• Hold antiplatelets and anticoagulants
• Consider reversal of anticoagulation with haematology input

Tranexamic acid should be given to all patients with severe bleeding.

Question 12

List some complications associated with epistaxis.

Answer 12

• Anaemia
• Recurrent epistaxis
• Hypovolaemia
• Aspiration of blood and airway compromise
• Septal perforation from nasal cautery
• Sinusitis, septal haematoma, or pressure necrosis from nasal packing

These complications can arise from both the condition and its treatment.

Question 13

What is used first line for epistaxis?

Answer 13

Nasal cautery when simple direct compression measures

Question 14

What is second line for uncontrolled bleeding?

Answer 14

Nasal packing

Question 15

What is a cause of recurrent epistaxis with red spot around lips?

Answer 15

haemorrhagic telangiectasia (HHT) an autosomal dominant condition characterised by multiple telangiectasia over the skin and mucous membranes. Twenty percent of cases occur spontaneously without prior family history