Epistaxis

exp date isn't null, but text field is

Introduction

Epistaxis refers to bleeding from the nose of any cause. It is a clinical presentation rather than a disease entity. 

Aetiology

  • Commonly from ruptured vessels in the anterior nasal septum, but sometimes from the posterior nose especially in the elderly. Can arise from a wide variety of causes. 
    • Local (in the nose)
    • Trauma
    • Inflammation of the nose or sinuses
    • Acute e.g. acute rhinitis/sinusitis
    • Chronic e.g tunerculosis, leprosy, neoplasms
    • Manifestation of systemic diseases
    • Bleeding disorders
    • Blood dyscrasias
    • Hypertension

Clinical Features

  • Intermittent bleeding from the nose, often spontaneous, but may follow obvious trauma or injury, could vary from few drops of blood to torrential life-threatening bleeding. 
  • Most bleeding stops spontaneously. 

Differential Diagnoses

  • Local and systemic illnesses may present with nasal bleeding

Complications

  • Haemorrhagic shock
  • Fatality

Investigations

  • FBC, including platelet count
  • Bleeding and clotting time; APTT
  • Serum electrolyte, urea and creatinine
  • X-ray sinuses
  • CT scan
  • Nasal endoscopy

Treatment Goals

  • To arrest bleeding
  • Replace lost blood and treat shock
  • Treat causes

Non-drug Treatment

  • Pressure and compression of the nose between fingers to arrest bleeding
  • Cotton wool pack soaked in epinephrine 1:1000 may be placed on bleeding area before compression to induce vasoconstriction
  • Nasal packing with lubricated rubber gauze 
  • Arrest of posterior bleed with rubber tampon or improvised Foley's catheter balloon
  • Cauterization of bleeding point or dilated vessels in anterior septum 
    • Diathermy cautery (electrical) or chemical cautery with silver nitrate stick
    • Endoscopic identification and arrest of bleeding points by ligation or cautery

Drug Treatment

  • Treat underlying causes
  • Sedation if necessary
    • Diazepam 5mg orally twice daily for 1 - 2 days
  • Antibiotics if infection is present
  • Amoxicillin 
    • Adult 500mg orally 8 hourly for 5 - 7 days
    • Child 250 - 500 mg orally 8 hourly for 5 - 7 days
  • Other drugs depending on identified causative factors

Supportive Measures

  • Intravenous infusion, crystalloids and blood as necessary
  • Bed rest

Prevention 

  • Avoid/treat predisposing conditions