Epistaxis 👃🩸

✍️Add to Tasks

🧯 Safety & PPE

  • Always don PPE: gloves, gown, goggles (“3 Gs”) before examining.
  • Assess ABCs and ensure hemodynamic stability before nasal exam.

🧠 Definition

  • Bleeding from nasal mucosa, often anterior (Kiesselbach’s plexus).
  • May be spontaneous or trauma-related, often recurrent.

📞 Immediate Questions

  • How much blood? Persistent or resolved?
  • Side of bleed? Any clots or swallowing blood?
  • Anticoagulants or antiplatelets? (Warfarin, DOACs, aspirin)
  • Nose picking, trauma, recent nasal procedures?
  • Hypertension history?

📋 Common Causes

  • Local trauma (e.g. nose picking)
  • Dry nasal mucosa
  • HTN or anticoagulation
  • Bleeding disorders
  • Tumour (esp. if unilateral and recurrent)

🧾 History

  • Onset, side, volume, duration
  • Hx of bleeding diathesis or easy bruising
  • Current medications (especially anticoagulants)
  • Recent nasal surgery or oxygen use

🩺 Examination

  • Ensure patient has blown their nose gently to clear clots.
  • Check vitals – especially HR, BP, oxygenation.
  • Use a head torch or nasal speculum to inspect anterior septum (Kiesselbach’s plexus).
  • Look for clots, active bleeding, or deviation.
  • Posterior pharynx – check for dripping blood.
  • Note signs of coagulopathy (e.g. bruises, petechiae).

🔍 Investigations

  • FBC, U&E, coagulation profile only if bleeding is ongoing or patient is unstable.
  • Check INR if on warfarin.
  • Consider ECG in elderly if significant blood loss.

💊 Initial Management

  • Sit patient forward and pinch soft part of nose for 10–15 minutes.
  • Apply cold compress or ice pack to bridge of nose.
  • Use a nose clip or tongue depressors taped together if available.
  • Administer topical vasoconstrictor (e.g. adrenaline 1:10,000) with tranexamic acid if protocol allows.
  • Consider lidocaine with vasoconstrictor via atomizer for visualization.
  • If a bleeding point is visible: cauterize with silver nitrate (only one side).
  • If not controlled: insert nasal tampon (e.g. RapidRhino, Merocel, Nasopore) and inflate per protocol.

⚠️ Escalation

  • ENT referral if posterior bleed suspected or uncontrolled bleeding.
  • Admit if on anticoagulants, hypertensive crisis, or ongoing/recurrent bleeding.
  • Start antibiotics if packing used.
  • Correct any coagulopathy (e.g. vitamin K, FFP, platelet transfusion).
  • Reassess post-intervention; monitor vitals and observe for rebleed.

📦 Discharge & Follow-Up

  • If packed: anterior balloon may be deflated after 6 hours, posterior after 48+ hours.
  • Avoid nose blowing, strenuous activity, or hot drinks post-discharge.
  • Use nasal lubricants, saline sprays, and keep mucosa moist.
  • Follow-up with ENT if recurrent or unexplained bleeding.

Note Template

Ready-to-use clinical note structure

🕒 20 / 11 / 2025 — 22:38

ATRP re: epistaxis
Patient: [age] [sex]
Admission Dx: [reason for admission]
PMHx: [esp. anticoagulation, hypertension, nasal pathology]

🧾 Hx:
• Onset, side, severity (trickle vs profuse)
• Duration and frequency
• Precipitating trauma or spontaneous
• Anticoagulants or antiplatelets?
• Previous episodes or nasal issues?

🩺 Exam:
• Vitals: HR __ BP __ RR __ SpO₂ __ Temp __
• Active bleeding? Side? Visible source?
• Nasal trauma, foreign body, mucosal dryness
• Look for posterior bleed (throat)

📋 Impression:
Likely [anterior / posterior] epistaxis

📌 Plan:
• Sit up, pinch soft part of nose x10–15 min
• Consider topical vasoconstrictor (e.g. co-phenylcaine)
• Cautery if visible anterior vessel
• Pack if ongoing bleeding
• Monitor obs ± bloods (FBC, coag)
• Escalate ENT if persistent or posterior

👤 [Your Name], [Role]
IMC: _______
✍️Add to Tasks