Epistaxis resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and keywords:

Overview

Epistaxis also known as noes bleeding, is a terminology name for bleeding of nose vessels that drains out from nostril (most often) and/or nasopharynx. Epistaxis is often stop easily but sometimes it's an ENT emergency which can be critical if appropriate action does not occur. Kiesselbach's plexus is the source of most epistaxis.

Causes

Base on the cause and severity of Epistaxis it can be life threatening.

Life Threatening Causes

Life-threatening causes of epistaxis include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Haemophilia
• Congestive heart failure
• Malignant hypertension

Common Causes

• Local trauma
• Acute sinusitis
• Allergic rhinitis
• Anticoagulation
• Aspirin
• Chronic rhinitis
• Chronic sinusitis
• Cocaine
• Common cold
• Foreign bodies
• Nose-picking
• Neoplasia

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Epistaxis according the the [...] guidelines.

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according to the [...] guidelines.

Statement Action Strength

Patient with Epistaxis

Does the patient need Immediate Action?

Yes→Volume replacement,airway check, Needs for emergency departement

No

Active Bleeding?

Yes→Nasal compression for≥5 min

No

Bleeding resume

Bleeding Conterolled

Rhinoscopy to identify location of bleeding

Risk assesment (Assess for Hereditary Hemoragic Telangiectasia

Bleeding site identified?

Rhinoscopy to identify location of bleeding

Yes→ Three options: ❑ 1=Lubricants ❑ 2=Topical vasoconstrictors ❑ 3=Nasal cautery

No

Bleeding site Identified

Bleeding site not identified

Decision for Nausal Cautery?

Anestesia bleeding site and limit Nasal cautery to site

Yes→ Anestesia bleeding site and limit Nasal Cautery to site

No

Bleeding controlled

Bleeding resume

Rist factor assessment

Suspected Bleeding site HHT* or Anticoagulants?

Patient education and prevention

NO→Non absorbable or Absorbable packing(Preferred in children)

Yes→Absorbable packing

Outcome Assesment

Nasal packing education

Discharge

Bleeding controlled

Bleeding resume

Patient use Anticoagulant or Antiplatelet medications

Patient doesn't use Anticoagulant or Antiplatelet medications

Patient Education and prevention

Life treatening Nose bleeding?

Outcome Assement

Yes→ Evaluate need for or risk of discontinuation Anti-Coag/Anti-Platelet medications

No

Discharge

Bleeding controled

Bleeding resume

Evaluate candidency for Embolization or Surgical arterial ligation

Appropriate intervention which may include Embolization, Surgery, Additional Nasal packing or Cautery

Patient Education and Prevention

Outcome Assesment

Discharge

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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