Damage to the blood vessels of the nasal mucosa
Causes/Factors
Local
- Trauma
- Inflammation
- Topical drugs (corticosteroids)
- Surgery
- Vascular issues (hereditary haemorrhagic telangiectasia, Granulomatosis with polyangiitis)
- Tumours (Squamous cell carcinoma)
General
- hypertension
- Atherosclerosis
- Increased venous pressure from mitral stenosis
- Haematological disorders
- Temperature, humidity or altitude
- Excessive alcohol consumption
Symptoms
- they have a nose bleed
Signs
- blood near the nose lol
Investigations
- FBC - if bleeding heavy or recurrent or Anaemia is supsected
- Coag - if clotting disorder is suspected
Management
ABCDE if haemodynamically unstable
- Person should sit with their upper body tilted forward and their mouth open - soft part of the nose should be pinched firmly for 10-15 mins
Acute Epistaxis management:
- First aid measures: lean forward, with their mouth open and pinch nose (15-20 minutes)
IF SUCCESSFUL: apply Naseptin cream(chlorhexidine and neomycin) to reduce crusting and risk of vestibulitis
IF UNSUCCESSFUL
- Cautery: if you can visualise the bleeding point.
- Anterior packing: if the bleeding point cannot be visualised.
IF UNSUCCESSFUL
- Posterior packing: urgent referral to ENT
IF UNSUCCESSFUL
- Admit to emergency department for sphenopalatine ligation in theatre
Recurrent epistaxis:
- Topical antiseptic treatment such as Naseptin cream to reduce crusting and vestibulitis, or
- Nasal cautery (if the expertise and facilities are available in primary care), or
- Referral to an ear, nose, and throat specialist if epistaxis is recurrent despite treatment, or there is a high risk of a serious underlying cause.
Complications/red Flags
- Hypovolaemia
- Anaemia