Epistaxis

Most nosebleeds arise from little’s area on the nasal septum. Five arteries anastomose to form little’s area:
1) Anterior Ethmoid Artery
2) Posterior Ethmoid Artery
3) Sphenopalatine Artery
4) Great Palatine Artery
5) Superior Labial Artery

Causes
Local:

• Idiopathic
• Trauma – nose picking, nasal fracture
• Drug Induced – Nasal sprays, anticoagulants
• Foreign Body
• Rhinitis

Systemic:

• Clotting disorders
• Hypertension
• Vasculitis (e.g Wegener’s Granulomatosis)
• Hereditary Haemorrhagic Telangiectasia (a.k.a Osler-Weber-Rendu disease, an autosomal dominant condition causing oral telangiectasia and epistaxis)

Management

• Airway, Breathing, Circulation!
• Gain IV access with a large bore cannula
• Send bloods for FBC, Group & Save and a clotting screen
• Give IV fluids
• Get the patient to sit upright, lean forwards and pinch the soft part of the nose
• Advise the patient to spit out any blood in the mouth
• Monitor pulse and blood pressure for signs of hypovolaemic shock
• If a bleeding vessel is visible consider cautery with silver nitrate
• Failing this pack the nose with Merocel nasal packs
• If examination suggests a posterior haemorrhage (i.e from the sphenopalatine artery) then try a balloon catheter to compress the bleeding vessel
• If this fails to stop the bleeding then the patient may need surgical ligation of the sphenopalatine artery

Written by Rachel Smith