Epistaxis

Don’t forget to wear protective gear. Gown up!



Initial Encounter



* History* Anticoagulants* Easy bleeding/bruising* Lightheadedness* Exam* Pallor* Tachycardia/Hypotension



Step 1: Put on Personal Protective Equipment



* Gown* Gloves* Mask* Eye Protection



Step 2: Clear Nose and Visualize Bleeding



* Have patient blow out/remove any clot and look for source of bleed* Kiesselbachs plexus* “Anterior” epistaxis* Sphenopalatine artery* “Posterior” epistaxis* Most severe/dangerous form



Step 3: Spray In Oxymetazoline (Afrin)



* Hold pressure for 15 minutes after initial application



Step 4: Cauterize With Silver Nitrate



* Avoid bilateral cauterizations* Can cause septal perforation* Anesthetize as necessary* 4% lidocaine on gauze and leave in nose for 10 minutes prior to cauterization



Step 5: Pack the Nose



* Multiple commercial products available for this* The utility of antibiotic prophylaxis at this step is unclear* Patient goes home with packing in place



Additional Reading



* Epistaxis Management (EM:RAP)