Epistaxis medical therapy
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Editor in Chief: C. Michael Gibson, M.S., M.D. [[1]] ; Associate Editor(s)-in-Chief: Liudvikas Jagminas, M.D., FACEP [1], Amir Behzad Bagheri, M.D.
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
The local application of a vasoconstrictive agent has been shown to reduce the bleeding time in benign cases of epistaxis. The drugs oxymetazoline or phenylephrine are widely available in over-the-counter nasal sprays for the treatment of allergic rhinitis, and may be used for this purpose.[1]
Chronic epistaxis resulting from a dry nasal mucosa can be treated by spraying saline in the nose up to three times per day.
Application of a topical antibiotic ointment to the nasal mucosa has been shown to be an effective treatment for recurrent epistaxis.[2] One study found it to be as effective as nasal cautery in the prevention of recurrent epistaxis in patients without active bleeding at the time of treatment (both had a success rate of approximately 50 percent.)[3]
Nosebleeds are rarely dangerous unless prolonged and heavy. Nevertheless they should not be underestimated by medical staff. Particularly in posterior bleeds a great deal of blood may be swallowed and thus blood loss underestimated. The elderly and those with co-existing morbidities, particularly of blood clotting should be closely monitored for signs of shock.
Recurrent nosebleeds may cause anemia due to iron deficiency.
As a summary; first aid of epistaxis includes:
- Tilt head forward, apply continuous pressure by pinching nares together to avoid posterior blood drainage (5-10 minutes)
- Apply silver nitrate to bleeding vessel (if identified)
- Possible blood transfusions
- Platelet transfusion, vitamin K, fresh frozen plasma, clottin factor replacement for bleeding disorders (if necessary)
- Possible ENT consult
References
- ↑ Guarisco JL, Graham HD (1989). "Epistaxis in children: causes, diagnosis, and treatment". Ear Nose Throat J. 68 (7): 522, 528–30, 532 passim. PMID 2676467.
- ↑ Kubba H, MacAndie C, Botma M, Robison J, O'Donnell M, Robertson G, Geddes N (2001). "A prospective, single-blind, randomized controlled trial of antiseptic cream for recurrent epistaxis in childhood". Clin Otolaryngol Allied Sci. 26 (6): 465–8. PMID 11843924.
- ↑ Murthy P, Nilssen EL, Rao S, McClymont LG (1999). "A randomised clinical trial of antiseptic nasal carrier cream and silver nitrate cautery in the treatment of recurrent anterior epistaxis". Clin Otolaryngol Allied Sci. 24 (3): 228–31. PMID 10384851.