Epistaxis

Introduction

Epistaxis is a condition of bleeding from the nose. It is a clinical presentation rather than a disease entity on its own.
Bleeding is most often from ruptured
vessels in the anterior nasal septum,
sometimes from the posterior nose especially in the elderly
Epistaxis can arise from a wide variety of causes

  1. Local (in the nose)
  • Trauma
  • Inflammation of nose or sinuses
    • Acute e.g. acute rhinitis/ sinusitis
    • Chronic e.g. tuberculosis, leprosy,
  • Neoplasms
  • Manifestation of systemic diseases
    • Bleeding diatheses
    • Blood dyscrasias
    • Hypertension

Clinical features

  • Bleeding from nose; often spontaneous but may follow obvious trauma or injury
  • Varying amounts of blood, from few drops to torrential life-threatening haemorrhage
  • Often intermittent; most bleeds stop
    spontaneously

Differential diagnoses

  • Various pathological conditions, both local and systemic present with nasal bleeding

Complications

  • Haemorrhagic shock
  • Fatality

Investigations

  • Full Blood Count, including platelet count
  • Bleeding and clotting time; partial thromboplastin time
  • Urea and Electrolytes and Creatinine
  • X-ray sinuses
  • CT scan

Treatment objectives

  • To arrest bleeding in actively bleeding cases
    Replace significant blood losses and treat shock
  • Identify and treat aetiological factors

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 ribbon gauze
  • Arrest of posterior bleed with rubber tampon or improvised Foley’s catheter balloon
  • Cauterization of bleeding point or dilated vessels in anterior nasal septum
  • Diathermy cautery (electrical) or
    chemical cautery with silver nitrate stick

Drug treatment

  • Treat underlying aetiologies
  • Sedation if necessary
  • Diazepam 5 mg orally twice daily for 1-2 days
  • Antibiotics if infection is present

Amoxicillin

  • Adult: 500 mg orally every 8 hours for 5 – 7 days
  • Child: 250-500 mg orally 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