Epistaxis

A common condition occurring more frequently in the young and the old.

95% arise at Little's area of the anterior septum, the location of the Kiesselbach plexus.

Precipitating factors include dry weather and other causes of nasal mucosal inflammation or hyperaemia, minor trauma, and medication. Although rare, neoplasm may also cause nosebleed.

Firm pressure on both nostrils for at least 10 minutes often stops the bleeding. Topical anaesthesia and vasoconstriction are also helpful for initial treatment of active bleeding. If initial measures fail, almost all episodes may be controlled with cautery, or anterior or anterior-posterior packing techniques.

Bleeding may be refractory in the presence of coagulopathy, anticoagulants, or antiplatelet therapy.

Epistaxis, or nosebleed, is bleeding from the nostril, nasal cavity, and/or nasopharynx and may be classified as anterior or posterior.[1]Tan L, Calhoun K. Epistaxis. Med Clin North Am. 1999 Jan;83(1):43-56. http://www.ncbi.nlm.nih.gov/pubmed/9927959?tool=bestpractice.com [2]Perretta L, Denslow B, Brown C. Emergency evaluation and management of epistaxis. Emerg Med Clin North Am. 1987 May;5(2):265-77. http://www.ncbi.nlm.nih.gov/pubmed/3436294?tool=bestpractice.com [3]Santos P, Lepore M. Epistaxis. In: Bailey B, Healy G, Johnson J, et al., eds. Head & neck surgery-otolaryngology. Philadelphia: Lippincott, Williams & Wilkins; 2001:415-428.[4]Massick D, Tobin E. Epistaxis. In: Cummings C, Flint P, Harker L, et al., eds. Otolaryngology-head and neck surgery. Philadelphia: Elsevier Mosby; 2005:942-961.

This topic does not cover epistaxis as a result of major trauma or epistaxis in pregnancy.