Transcript Epistaxis - Resident Rounds at Academic Day

Epistaxis
JAGDEEP DOULLA
PGY-2
FAMILY MEDICINE
PRIMROSE FAMILY HEALTH CENTER
Outline
 Epidemiology
 Anatomy
 Case
 Diagnosis
 Anterior Bleed Management
 Posterior Bleed Management
 References
History
 60% of individuals worldwide will get a nose bleed in
their lifetime
 Average age of patients presenting to FD or ED
 Children <10 years old
 Adults > 35 years old
Anterior Circulation
 External carotid  facial
artery and
sphenopalatine artery
 Internal carotid 
anterior and posterior
ethmoidal arteries
 90% bleeds at
Nasal Septum
Kiesselbach’s Area
Posterior Circulation
 External Carotid 
sphenopalatine branch of
the internal maxillary
artery
 Common in older
patients

Lateral Nasal Wall
>64 years old
Common is Common
Case
 65 yo male presents with right sided epistaxis
 Hx of HTN

Medications
Atenolol
 ASA

Patient Evaluation
 Ensure patent airway
 Hemodynamic stability
 History
 Duration
 Frequency
 Severity
 Inciting factors
 Family hx of bleeding problems
Diagnosis
 Common Causes
 Chronic Sinusitis
 Epistaxis Digitorum
 Foreign Bodies
 Neoplasms & Polyps
 Irritants
 Medications – topics steroids
 Rhinitis
 Septal deviation
 Septal perforation
 Trauma
 Vascular malformations or
telangiectasia's
 Systemic Causes
 Hemophilia
 Hypertension
 Leukemia
 Liver disease – cirrhosis
 Medications
 ASA
 Anticoagulants
 NSAID’s
 Platelet dysfunction
 Thrombocytopenia
Approach to Anterior Bleed
 Lidocaine with
phenylephrine spray to
help examine and slow
down some of the
bleeding

If available cocaine can be
used
 Septal Pressure for 5-20
min
 Anterior Packing



Cotton swabs
Ribbon gauze
impregnated with
petroleum jelly
Nonadherent gauze
 Chemical Cautery

Silver nitrate
 Electric Cautery
Anterior Packing
Approach to Posterior Bleed
 Posterior Packing

Usually required in older
individuals taking blood
thinners
If you can visualize the
bleed
 Chemical Cautery

Silver nitrate
 Electric Cautery
Posterior Packing
References
 Kucik, CJ., Clenny, T. 2005. Management of
Eppistaxis. AAFP (71) pg 305-311.
 Schlosser, RJ. 2009. Epistaxis. New England Journal
of Medicine 360(8) pg 784-789.