Management

Management

• most patients can be treated as outpatients (2)
• hospital admission may be necessary for (2)
  • elderly patients
  • posterior bleeding
  • coagulopathy
  • complicating comorbid conditions such as
    • coronary artery disease, severe hypertension, severe anemia
    • a complete epistaxis tray ashould always be kept ready

Contents of an epistaxis tray include (2):

• nasal decongestant sprays
• local anesthetics
• 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 (2)

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 (3)

Reference:

• 1. Nosebleed (Epistaxis). medical content reviewed by the faculty of Harvard Medical School, 2007
• 2. Kucik CJ. Management of epistaxis.American Family Physician 2005; 71(2)
• 3. Cartwright SJ, Morris JJ, Pinder D. Managing nosebleeds. Student BMJ 2008;16:212-214