Epistaxis

A excellent and extremely funny video from the folks over at Short Sharp Scratch that tells you everything you need to know about epistaxis. You won't forget this episode in a hurry!

Lecture by

Video Duration: 13 minutes

  • Epistaxis
    Created by Robert Jackson
    General
    Epidemiology

    Haemorrhage from vessels in the nose, can be anterior or posterior. Anterior is more common.

    Pathology

    Bleeding commonly from Kiesselbach's plexus.

    Usually idiopathic or trauma. Hypertension and anti-coagulation may predispose.

    Rare causes include; Wegener's, bleeding disorders, tumours and Osler-Weber-Rendu syndrome (aka. Hereditary haemorrhagic telengiectasia).

    Top three causes

    Trauma / Foriegn Body

    Hypertension

    Anti-coagulants

    Clinical Features
    Symptoms

    Bleeding

    Symptoms of aspiration (coughing) suggest posterior bleed.

    Signs

    Clean and examine with nasal speculum,

    Where is the bleeding? Unilateral, bilateral?

    Investigations
    Cultures

    None

    Bloods

    Full blood count, clotting screen, group and save (if severe or known coagulation defect)

    Imaging

    Not usually indicated.

    Scopic/Biopsy

    None

    Functional

    None

    Treatment
    Conservative

    Most resolve with conservative management.

    Pinch/pressure on soft part of nose. Tilt head forward. Ice pack on nose bridge.

    Medical

    Cauterize:

    • Wash nose with Naseptin cream (peanut allergy is contraindication!)
    • Visualise bleed
    • Silver nitrate sticks (beware bilateral cauterisation of septum can cause perforation!)

    Nasal packing:

    • Rapid Rhino; like a "nasal tampon" - inserted and inflated with water or air from a 10ml syringe.
    • Merocel; absorbs blood and expands within the nose.
    • Bipp Gauze - ribbon like material inserted with forceps.
    • Bilateral packing may be more effective due to increased pressure.
    Surgical

    If bleeding doesn't stop or if suspected posterior bleed, call ENT for posterior packing by insertion of a Foley Catheter.

    Refractory bleeding may require artery ligation or embolisation.