Epistaxis

Question 1

Sequence of events and epistaxis

Answer 1

Open question 
Onset
Duration- has it gotten worse
Frequency- continuous 
Which nostril
Trickling down back of throat

Question 2

Systems review

Answer 2

ENT- loss of sense of smell, rhinorhoea, obstruction, headaches, otalgia, discharge, change in hearing, tinnitus

Constitutional- FWARJNLC

Bleeding elsewhere eg. Hameaturia, melaena, petechiae, bruising etc.

Symptoms of anaemia/hypovolaemia- chest discomfort, dyspnoea, light headed ness

Question 3

Patients perspective

Answer 3

Feelings and impact on life

ICE

Question 4

Questions to ask to identify cause

Answer 4

Nose picking 
Recent trauma or fall
Foreign body 
Recent surgery to nose or face 
Anticoagulants (prescribed or over the counter)
HTN 
Bleeding disorders (haemophilia)
Nasal sprays (glucocorticoids)

Question 5

Background information

Answer 5

PMH- bleed easily, nosebleeds
DH- warfarin, heparin, clopidogrel, aspirin, allergies, OTC (eg. warfarin and st johns wart)
SH
FH- easy bleeding, nosebleeds etc.

NB- if on warfarin, compliant? Attend INR clinics?

Question 6

Management

Answer 6

ABCDE (like any bleed)
Bloods- FBC UE LFT CRP coagulation screen INR
Anterior septal pressure
Silver nitrate cautery
Rapid rhino if needed
ENT on call review- surgery for shpenopalatine artery ligation

Question 7

Causes of epistaxis

Answer 7

Spontaneous
Trauma
Tumours
HTN 
Haemophilias
Anticoagulant therapy (esp. if taking aspirin OTC) 

NB- if a bleed lasts longer than 15 minutes, go to AE