What is the treatment for epistaxis?

Treatment of Epistaxis

The primary treatment for epistaxis is to have the patient sit with their head slightly forward while pinching the lower third (soft portion) of the nose firmly for 10 to 15 minutes. 1

First-Line Management

Initial Assessment and Immediate Management

• Determine if the patient requires prompt management based on:
  • Severity of bleeding (active vs. stopped)
  • Hemodynamic stability
  • Airway concerns
  • Risk factors (anticoagulant use, bleeding disorders)

First Aid Measures

1. Position the patient properly:

   • Seated upright
   • Head tilted slightly forward (prevents blood from entering airway or stomach) 1
   • This position reduces risk of aspiration and vomiting

2. Apply direct pressure:

   • Firmly pinch the lower third/soft portion of the nose 1
   • Maintain compression continuously for 10-15 minutes
   • Patient should breathe through mouth and spit out any blood 1
   • This allows time for clot formation

3. Additional first-line interventions (if bleeding site is identified):

   • Topical vasoconstrictors (e.g., oxymetazoline) 1, 2
   • Nasal cautery (for visible bleeding sites) 1
   • Moisturizing/lubricating agents 1

When to Seek Medical Attention

Medical attention should be sought if:

• Bleeding doesn't stop after 15 minutes of continuous pressure 1
• Patient becomes lightheaded from blood loss 1
• Epistaxis is due to trauma with signs of brain injury, nasal deformity, or facial fracture 1
• Patient is taking anticoagulant/antiplatelet medications or has a bleeding disorder 1

Advanced Management (by Healthcare Professionals)

If first-line measures fail, additional interventions include:

1. Nasal Packing:

   • For ongoing active bleeding 1
   • Use resorbable packing for patients with bleeding disorders or on anticoagulants 1
   • Various options include petroleum jelly, nasal tampons, balloons 2

2. Endoscopic Evaluation and Treatment:

   • Nasal endoscopy to identify bleeding sites not visible on anterior rhinoscopy 1
   • Endoscopic cauterization or arterial ligation for persistent bleeding 2

3. Surgical/Interventional Options (for refractory cases):

   • Surgical arterial ligation 1
   • Endovascular embolization 1, 2

Special Considerations

Patients on Anticoagulants

• In the absence of life-threatening bleeding, initiate first-line treatments before considering reversal or withdrawal of anticoagulation 1
• These patients should seek medical care unless bleeding has completely stopped 1

Recurrent Epistaxis

• Assess for underlying conditions like hereditary hemorrhagic telangiectasia 1
• Consider preventive measures like nasal moisturization 1

Common Pitfalls to Avoid

1. Incorrect head positioning: Tilting head backward can cause blood to flow into throat, risking aspiration or vomiting 3
2. Inadequate compression time: Many patients release pressure too soon (before 10 minutes) 3
3. Incorrect compression location: Only 30% of healthcare providers correctly identified the proper site for nasal compression in one study 3
4. Overuse of cryotherapy: The usefulness of ice/cold applications for epistaxis is unproven and not recommended as primary treatment 1

Patient Education

Patients should be educated about:

• Proper technique for home management of nosebleeds
• Preventive measures (avoiding nose picking, humidification)
• Warning signs that require medical attention
• Expected outcomes and potential complications if packing was placed 1

Most cases of epistaxis (90-95%) can be effectively managed with proper first aid measures 3, 4, making correct application of these techniques crucial for both patients and healthcare providers.