epistaxis

Packing

Self resolving epistaxis recommendations:

  • Humidified O2/air at all times if requiring oxygen
  • Minimize nasal manipulation as able (picking, nose blowing, sneezing/coughing with mouth closed)
  • Nasal saline spray (Ocean spray) q4 hours to bilateral nares while awake. Apply directly to the nasal pack.
  • Afrin Nasal Saline spray to bilateral nares every 6 hours for 48 hours. Apply directly to the nasal pack.

In the event of nose bleeding:

  • Firmly/uncomfortably pinch the inferior nose at the bony/cartilaginous junction and hold pressure for 10 minutes by the clock. Lean forward to avoid swallowing the blood and breathe through the mouth. It may help to apply cold compresses or ice across the bridge of the nose. Do NOT pack the inside of the nose with gauze.
  • If bleeding persists, spray the affected nostril with 1/4 to 1/3 a bottle of Afrin (oxymetazoline) and hold pressure for another 10 minutes by the clock
  • If the bleeding stops, do NOT sniff or blow the nose for 24-48 hours (this can restart the bleeding). Use nasal saline to irrigate the blood out of the nose as above.

The most appropriate management is nasal endoscopy. Ninety percent of episodes of epistaxis occur in the anterior nasal septum in the Kiesselbach area. Anterior bleeding can be managed with compression for at least 5 minutes. Posterior epistaxis (behind the posterior middle turbinate, requiring a nasopharyngoscope for visualization) may be more difficult to manage and is more common in older patients. Common causes of epistaxis include topical intranasal medications (such as glucocorticoids or antihistamines), dehumidification, and self-induced digital trauma. Among patients with epistaxis serious enough to require hospitalization, almost half have a causal systemic condition, such as anticoagulation, hemophilia, hematologic malignancy, neoplasm, and acquired coagulopathies from kidney or liver disease. Recurrent unilateral epistaxis may represent a neoplasm; hence, this patient should be referred for nasal endoscopy.