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Introduction

Most nosebleeds arise from little’s area on the nasal septum. Five arteries anastomose to form little’s area:

  1. Anterior Ethmoid Artery
  2. Posterior Ethmoid Artery
  3. Sphenopalatine Artery
  4. Great Palatine Artery
  5. Superior Labial Artery

Causes

Local

  • Idiopathic
  • Trauma – nose picking, nasal fracture
  • Drug Induced – Nasal sprays, anticoagulants
  • Foreign Body
  • Rhinitis

Systemic

  • Clotting disorders
  • Hypertension
  • Vasculitis (e.g Wegener’s Granulomatosis)
  • Hereditary Haemorrhagic Telangiectasia (a.k.a Osler-Weber-Rendu disease, an autosomal dominant condition causing oral telangiectasia and epistaxis)

Management

  • Airway, Breathing, Circulation!
  • Gain IV access with a large bore cannula
  • Send bloods for FBC, Group & Save and a clotting screen
  • Give IV fluids
  • Get the patient to sit upright, lean forwards and pinch the soft part of the nose
  • Advise the patient to spit out any blood in the mouth
  • Monitor pulse and blood pressure for signs of hypovolaemic shock
  • If a bleeding vessel is visible consider cautery with silver nitrate
  • Failing this pack the nose with Merocel nasal packs
  • If examination suggests a posterior haemorrhage (i.e from the sphenopalatine artery) then try a balloon catheter to compress the bleeding vessel
  • If this fails to stop the bleeding then the patient may need surgical ligation of the sphenopalatine artery

References

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