Epistaxis

Epistaxis (nosebleed) is a common condition with a bimodal age distribution, occurring more frequently in the young and the old.

90% 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 hyperemia, such as allergy, viral rhinitis, bacterial rhinosinusitis, dust, or chemicals. Although rare, neoplasm may also cause nosebleed.

Topical anesthesia and vasoconstriction are essential for initial treatment of active bleeding. If initial measures fail, almost all episodes may be controlled with anterior or anterior-posterior packing techniques.

Bleeding may be refractory in the presence of coagulopathy.

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; 2001:415-28.[4]Massick D, Tobin E. Epistaxis. In: Cummings C, Flint P, Harker L, et al., eds. Otolaryngology-head and neck surgery. Philadelphia: Elsevier Mosby; 2005:942-61.