Epistaxis
Print Friendly, PDF & Email

almostadoctor app banner for android and iOS almostadoctor iPhone, iPad and android apps almostadoctor iOS app almostadoctor android app

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

Read more about our sources

Related Articles

Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

Leave a Reply