Management
- most patients can be treated as outpatients
- hospital admission may be necessary for;
- elderly patients
- posterior bleeding
- coagulopathy
- complicating comorbid conditions such as
- coronary artery disease, severe hypertension, severe anaemia
- a complete epistaxis tray should always be kept ready. Contents of an epistaxis tray include:
- nasal decongestant sprays
- local anaesthetics
- silver nitrate cautery sticks
- bayonet forceps
- nasal speculum
- Frazier suction tip
- posterior double balloon system and syringe for balloon inflation
- packing materials
- suction cautery
General measures include:
- monitoring vital signs - blood pressure, pulse rate
- maintaining a patent airway
- maintain haemodynamic stability
- intravenous infusion
- review of medication, especially anticoagulants
- taking blood for full blood count, group and save, cross-match, coagulation studies
In haemodynamically stable patients, consider the following to stop bleeding
- first aid measures
- cautery - used in epistaxis that is refractory to first aid measures and if the bleeding site can be identified
- nasal packing - if bleeding continues despite cautery methods or if the bleeding point cannot be seen
- if nasal packing fails refer the patient to secondary care for further management
Reference
- National ENT Trainee Research Network. The British Rhinological Society multidisciplinary consensus recommendations on the hospital management of epistaxis. J Laryngol Otol. 2017 Dec;131(12):1142-56.