JAGDEEP DOULLA PGY-2

FAMILY MEDICINE PRIMROSE FAMILY HEALTH CENTER

Epistaxis

Outline

EpidemiologyAnatomy Case Diagnosis Anterior Bleed Management Posterior Bleed Management References

History

60% of individuals worldwide will get a nose bleed in their lifetime

Average age of patients presenting to FD or ED Children <10 years old Adults > 35 years old

Anterior Circulation

External carotid facial artery and sphenopalatine artery

Internal carotid anterior and posterior ethmoidal arteries

90% bleeds at Kiesselbach’s Area Nasal Septum

Posterior Circulation

External Carotid sphenopalatine branch of the internal maxillary artery

Common in older patients >64 years old

Lateral Nasal Wall

Common is Common

Case

65 yo male presents with right sided epistaxis Hx of HTN

Medications Atenolol ASA

Patient Evaluation

Ensure patent airwayHemodynamic stability

History Duration Frequency Severity Inciting factors Family hx of bleeding problems

Diagnosis

Common Causes Chronic Sinusitis Epistaxis Digitorum Foreign Bodies Neoplasms & Polyps Irritants Medications – topics

steroids Rhinitis Septal deviation Septal perforation Trauma Vascular malformations or

telangiectasia's

Systemic Causes Hemophilia Hypertension Leukemia Liver disease –

cirrhosis Medications

ASA Anticoagulants NSAID’s

Platelet dysfunction Thrombocytopenia

Approach to Anterior Bleed

Lidocaine with phenylephrine spray to help examine and slow down some of the bleeding If available cocaine

can be used Septal Pressure for 5-

20 min

Anterior Packing Cotton swabs Ribbon gauze

impregnated with petroleum jelly

Nonadherent gauze

Chemical Cautery Silver nitrate

Electric Cautery

Anterior Packing

Approach to Posterior Bleed

Posterior Packing Usually required in

older individuals taking blood thinners

If you can visualize the bleed

Chemical Cautery Silver nitrate

Electric Cautery

Posterior Packing

References

Kucik, CJ., Clenny, T. 2005. Management of Eppistaxis. AAFP (71) pg 305-311.

Schlosser, RJ. 2009. Epistaxis. New England Journal of Medicine 360(8) pg 784-789.