Home Forums Other Specialities ENT EPISTAXIS a guide

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    epistaxis

    Epistaxis is one of the commonest presentations at the accident and emergency (A&E) department and is the most common ENT emergency Most cases of nose bleeds are minor or self limiting but rarely can be a life threatening emergency due to massive bleeding

    An estimated 60 % of the general population has had at least one episode of epistaxis throughout their life time (2).

    out of these only 6% sought medical assistance for it
    1.6 in 10,000 required hospitalisation
    a bimodal distribution is seen in the population
    the incidence peaks at ages less than 10 years and above 50
    in the young, the blood comes from Little’s area, a highly vascular area at the anterior border of the nasal septum. With age the site of bleeding moves posteriorly
    rare in children under the age of 2 years and if present is often associated with injury or serious illness
    seasonal variation can also be seen with an increase during the winter months
    occurs frequently in males than in females
    the incidence peaks at ages less than 10 years and above 50

    Epistaxis may be due to local causes or general causes.

    Epistaxis is usually classified into two types:

    anterior bleeding
    posterior bleeding

    Epistaxis summary

    epistaxis is common
    an estimated lifetime prevalence in the United States of 60%
    approximately 6% of persons who have nosebleeds seek medical attention.
    management of epistaxis is straightforward in most cases but can be challenging in patients with cardiovascular disease, impaired coagulation, or platelet dysfunction.
    epistaxis is appropriately controlled in a systematic and escalating fashion
    initial management
    patients in the medical setting are advised to apply digital compression to the lower third of the nose for 15 to 20 minutes, which is followed by anterior rhinoscopy
    anterior bleeding can usually be controlled with topical vasoconstrictors, tranexamic acid, cautery, or anterior nasal packing
    intranasal tranexamic acid
    study evidence found addition of intranasal tranexamic acid to controlled topical therapy of phenylephrine and lidocaine was linked to a lower rate of need for anterior nasal packing, stay in A+E for >2hrs, and rebleeding in 24hrs
    continued epistaxis despite these measures requires more aggressive treatment, with the involvement of specialists in otolaryngology and head and neck surgery and, generally, hospital admission

    G Mohan.

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