Epistaxis - a guide for junior staff and nurses

BASIC PRESENTATION COVERING EPISTAXIS PRINCIPLES

1. Epistaxis (Nosebleeds) ENT House Officer

2. Introduction Common ENT presentation Most common in children and elderly Causes - trauma, mucosal dehydration Winter months – cold and dry 90% anterior bleeds Often self-limiting Posterior bleeds Can be severe and life-threatening Require prompt referral

3. Approach ABC Anterior vs posterior Duration of bleed Amount of blood loss NB underlying/precipitating factors Medications (warfarin, aspirin) Liver disease (high alcohol intake) Trauma

4. Adjuncts Ice Decongestants – Otrivin Cautery Silver nitrate Bipolar diathermy +/- nasal packing Rapid rhino Merocel Foley catheter – for posterior bleeds Acute referral to ENT

5. Tongue depressor Thudicum Tilly’s forceps Frazier suction

6. Post-epistaxis care Humidification Lubrication Vaseline Chlorsig Avoid activities that increase bloodflow to the nose Straining Heavy lifting Bending over Hot drinks Hot showers

7. Nasal packs Rapid rhino Foley catheter

8. Complications of packing Failure to stop bleeding Airway compromise Toxic shock syndrome (~16/100 000) Alar necrosis (pressure injury)

9. Surgical management Indicated for uncontrollable bleeding, even with 1-2 properly placed packs Options Diathermy Sphenopalatine artery ligation Selective embolization

10. Summary Common problem, most patients do not need to present Most frequently caused by dryness and trauma Consider contributing factors (coagulopathy, blood thinners) ABC first – then assess location and extent of bleeding 90% anterior bleeds If not settling with basic measures can refer to ENT Some patients will require packing Basic advice – humidification and lubrication, and avoidance of certain activities