Epistaxis

Epistaxis

A mother walks in with a 2year old child whose nose is bleeding profusely

• What questions will you ask?• How will you manage?

Interact!

What to ask ?

• First time/ recurrent • Bleeding tendency in the family• Foreign body insertion• Infectious (RTI ) • H/o trauma /nasal picking • Use of drugs*

Classification of Epistaxis

• Primary –no obvious cause • Mild – no hemodynamic

alteration• Anterior : Kiesselbach’s

plexus/Littles area • Seasonal : cold dry months• Unilateral : one nostril bleed

• Secondary-cause present• Moderate to severe-

hemodynamically unstable• Posterior : Woodruff's

plexus• Perennial: throughout year • Bilateral : bleeds into throat

or from both nostrils

Evaluate

• History

• Airway , Breathing , Circulation

• Hemodynamics – BP, O2, CRT,

• Skin and retina – erythema, rash, petechial

Management

History of Active bleeding

*ABC- Assess for hypovolemic shock (start IV fluids)

Steps

in

Managing

epistaxis

When not to ignore ??

When to refer ?

• Recurrent epistaxis• Uncontrollable epistaxis• Posterior epistaxis• Haemotympanum• Facial trauma• Polyps / tumors.

• Don’t sneeze. If unavoidable, try to sneeze with the mouth open.• Don’t drink or eat anything hot for 24 hours after a nosebleed,

hot drinks can expand the blood vessel in the lining of your nose and cause fresh Bleeding.

• Don’t attempt to remove any packing applied by a doctor • Don’t lift heavy objects or attempt strenuous exercise for one

week.• Don’t bathe with hot water for 24 hours• Don't underestimate the amount of blood that can be lost from

epistaxis.

Some don’t’s