Epistaxis medical therapy

Epistaxis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Epistaxis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT Scan
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Epistaxis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Epistaxis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Epistaxis medical therapy
CDC on Epistaxis medical therapy
Epistaxis medical therapy in the news
Blogs on Epistaxis medical therapy
Directions to Hospitals Treating Epistaxis
Risk calculators and risk factors for Epistaxis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief:Amir Behzad Bagheri, M.D. José Eduardo Riceto Loyola Junior, M.D.[2]

Overview

Most of the time no action is needed to stop epistaxis. In active bleeding nasal compression is the first line to stop bleeding. If bleeding continues there are other options like cautery and some vasoconstrictive agents like oxymetazoline or phenylephrine to control bleeding.

Medical Therapy

If nasal bleeding is active and nasal compression couldn't stop bleeding, there are the following medical options:

• 
  General management of patients is important. Stabilizing the patient and treating the specific cause is the basis of management.

• 
  At first airway , breathing and circulation should be evaluated.

Epistaxis Treatment by a primary care physician or emergency physician

❑ Compression of the nostrils ❑ Ice application to the neck area ❑ Upright sitting position ❑ Blood to be spat out ❑ Take blood pressure, lower if appropriate

Patient hemodinamically stable, bleeding stops

Patient hemodinamically unstable

Patient hemodinamically stable, bleeding persists

*30min observation, *Antiseptic nasal cream

*Emergency transfer to ENT department *Volume replacement

Bleeding stops: ❑ Discharge patient home ❑ Prevent recurrence; ❑ Nasal mucosal care ❑ No nose-blowing for 7-10 days

Bleeding resumes

Emergency referral to otorhinolaryngologist

Anterior rhinoscopy Endoscopy if required

Source of bleeding visible, anterior

Source of bleeding not visible and/or posterior

Bleeding stops: ❑ Discharge patient home ❑ Prevent recurrence; ❑ Nasal mucosal care ❑ No nose-blowing for 7-10 days

Eletrocoagulation or silver nitrate cautery; Hemostatic gauze if required

Bleeding persists: Nasal packing

Nasal packing

Treatment of epistaxis in the ENT department

Bleeding stops

Bleeding persists, patient fit for surgery

Bleeding persists, patient not fit for surgery

Remove packing after 48h, antibiotics if needed

Surgical treatment, usually endoscopic sphenopalatine ligation

Embolization

If bleeding persists, embolization

If bleeding persists: Patient fit for surgery - surgery Patient not fit for surgery - embolization

Medical Therapy:

• Vasoconstrictors (Use with caution in children and patients with glaucoma, HTN, peripheral vasoconstriction, cardiac diseases and cerebrovascular problems):
  • Preferred regimen (1): Oxymetazoline 0.05% intranasal spray. In children <6 years just with physicians suggestion.
  • Alternative regimen (1): Phenylephrine 0.25% intranasal spray. In children ≥2 years Phenylephrine 0.125% nasal solution can be used.
  • Alternative regimen (2): Epinephrine 1:100,000 with Lidocaine 1% (Topical ).

• Antifibrinolytic:
  • Preferred regimen (1): Tranexamic acid (TXA) (Topical ). In coagulopathy and HHT patients is preferred.
    

• Chemical cauterization ( At first anesthesia bleeding site and limit nasal cautery to site:
  • Preferred regimen (1): Silver nitrate 25%-75%
  • Alternative regimen (1): Chromic acid
  • Alternative regimen (2): Trichloroacetic acid

• Some medicines are used to prevent epistaxis:
  • Emollient creams : Continues using of topical emollient creams is useful to prevent epistaxis.
  • Ointments : Continues using of topical ointments is useful to prevent epistaxis