management

Last edited 09/2021 and last reviewed 07/2022

Management

  • most patients can be treated as outpatients (2)
  • hospital admission may be necessary for (2)
    • elderly patients
    • posterior bleeding
    • coagulopathy
    • complicating comorbid conditions such as
      • coronary artery disease, severe hypertension, severe anemia
      • a complete epistaxis tray ashould always be kept ready

Contents of an epistaxis tray include (2):

  • nasal decongestant sprays
  • local anesthetics
  • silver nitrate cautery sticks
  • bayonet forceps
  • nasal speculum
  • Frazier suction tip
  • posterior double balloon system and syringe for balloon inflation
  • packing materials
  • suction cautery

General measures include:

  • monitoring vital signs - blood pressure, pulse rate
  • maintaining a patent airway
  • maintain haemodynamic stability
  • intravenous infusion
  • review of medication, especially anticoagulants
  • taking blood for full blood count, group and save, cross-match, coagulation studies (2)

In haemodynamically stable patients, consider the following to stop bleeding

  • first aid measures
  • cautery - used in epistaxis that is refractory to first aid measures and if the bleeding site can be identified
  • nasal packing - if bleeding continues despite cautery methods or if the bleeding point cannot be seen
  • if nasal packing fails refer the patient to secondary care for further management (3)

Reference: