Epistaxis
Classification
[edit | edit source]- Anterior
- By far the most common
- Mostly self-limiting
- Mostly Kiesselbach's plexus - anastomosis of the septal branch of anterior ethmoidal artery, lateral nasal branch of the sphenopalatine artery, and the septal branch of the superior labial branch of the facial artery
- Posterior
- Mostly from the posterolateral branches of the sphenopalatine artery, but sometimes from ICA branches
- Can result in significant haemorrhage
Contributing factors
[edit | edit source]- Nose picking
- Mucosal dryness
- Septal perforations
- Anticoagulation - usually don't need to reverse
- Neoplasm - SCC
- HTN
- Alcohol
Approach
[edit | edit source]- Initial tamponade - pinch ala tightly against septum and do not release for 10 minutes
- Examine with good lighting and a nasal speculum
- Look carefully at Kiesselbach's plexus
- Treatment of anterior bleeding
- Silver nitrate
- Anterior balloon (5cm Rapid Rhino) soaked in tranexamic acid or water for 30 sec
- If still persisting, also pack other side
- If still persisting, likely posterior source
- Posterior bleeding
- Insert posterior packing balloon (7.5cm Rapid Rhino, soaked in water for 30sec)
- Can also be done with Foley catheter 10-14Fr, coated with lube, advanced to the posterior oropharynx, inflated with 5-7mL, then gently retracted til it pops back up into the posterior nasopharynx and tamponades the bleeding. At this point another 5mL of water can be added to the balloon.