Epistaxis

Question 1

How are nosebleeds often treated?

Answer 1

By pinching in front of the bony bridge of nose for 15/20 minutes and leaning forward

(pinch squishy part of nose)

Question 2

Blood supply to nose

Answer 2

Mainly from maxillary arteries - sphenopalatine and greater palatine
Internal carotid - posterior and anterior ethmoidal arteries
Facial artery - superior labial artery

Question 3

Where do most nosebleeds originate from?

Answer 3

90% from Littles/Kiesselbachs area
10% from sphenopalatine artery (posterior)

Question 4

Which bleed is worse and why?

Answer 4

Sphenopalatine - blood at higher pressure and posterior in nasal cavity so harder to reach and stop bleed

Question 5

Causes of nosebleeds?

Answer 5

Spontaneously or with minor trauma eg nose picking, blowing nose

Could be underlying systemic disease eg connective tissue disorder

Question 6

Who mostly gets nosebleeds?

Answer 6

Very young - 2-10 yr olds
Old - older than 50-60 year olds

Question 7

Can nosebleeds be life threatening?

Answer 7

Yes - serious bleeds can occur where significant blood is lost and can cause death (but rare)

Question 8

What is next step is compression of nose does not stop bleed?

Answer 8

Cauterisation using silver nitrate

Question 9

Next step if cauterisation does not work

Answer 9

Anterior packing using nasal tampon - expand within cavity and tamponade bleed

Question 10

Next step after anterior packing

Answer 10

Posterior packing and surgical intervention eg ligation of blood vessels

Question 11

What should be monitored in severe epistaxis?

Answer 11

ABC - airway, breathing and circulation - check Hb, clotting etc