From the Guidelines
Epistaxis, or nosebleed, should be managed through a stepwise approach starting with first aid measures, and patients taking anticoagulation medications should be closely monitored due to the increased risk of severe bleeding 1. The initial management of epistaxis involves pinching the soft part of the nose firmly for 10-15 minutes while leaning slightly forward to prevent blood from flowing down the throat.
- Apply an ice pack to the bridge of the nose to constrict blood vessels.
- If bleeding persists, nasal decongestant sprays like oxymetazoline can be applied to help constrict blood vessels.
- For recurrent nosebleeds, petroleum jelly can be applied inside the nostrils twice daily to prevent dryness.
- Humidifiers in the home can also help maintain nasal moisture. If bleeding is severe or doesn't stop after 20-30 minutes of pressure, medical attention should be sought immediately. In clinical settings, treatment may include nasal packing, chemical or electrical cauterization, or rarely surgical intervention for severe cases 1. Most nosebleeds occur in the anterior part of the nasal septum (Kiesselbach's plexus) and are caused by trauma, dryness, or irritation. Posterior bleeds are less common but more serious and typically require medical intervention. Underlying conditions like hypertension, blood disorders, or medications like anticoagulants can contribute to more severe epistaxis and may need specific management 1. The management of epistaxis should prioritize control of acute bleeding, prevention of recurrent episodes of nasal bleeding, and minimization of complications of treatment modalities, while also considering the patient's quality of life (QOL) 1. It is essential to note that epistaxis can account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters, highlighting the importance of proper management and treatment 1.
From the Research
Definition and Treatment of Epistaxis
- Epistaxis refers to bleeding from the nostrils, nasal cavity, or nasopharynx 2.
- The treatment options for epistaxis include first aid measures such as external pressure and ice packing, applying topical agents like oxymetazoline, electrocautery, and chemical cauterization 2.
- Nasal packing can be applied using non-absorbable materials like petroleum jelly, BIPP gauze, and PVA nasal tampons, as well as absorbable materials like nasal tampon and newer hemostatic materials 2.
Outpatient Management of Epistaxis
- Up to 60% of the general population experiences epistaxis, and 6% seek medical attention for it 3.
- Evaluation of a patient presenting with epistaxis should begin with assessment of vital signs, mental status, and airway patency 3.
- Compressive therapy is the first step to controlling anterior epistaxis, and oxymetazoline nasal spray or application of cotton soaked in oxymetazoline or epinephrine 1:1,000 may be useful adjuncts 3.
Treatment Options and Their Effectiveness
- Oxymetazoline can be used to effectively treat epistaxis, avoiding nasal packing, with a success rate of 65% as sole therapy and an additional 18% when combined with silver nitrate cautery 4.
- Endoscopic ligation of arteries and endoscopic cauterization are more effective than conventional nasal packing and ligation, respectively 2.
- Embolization can be applied using gelatin sponge, foam, PVA, and coils with an 80% success rate and comparable efficacy and complications to surgical methods 2.
Practical Pointers for Nosebleed Control
- Topical anesthetic and decongestant agents are essential in the treatment of epistaxis, and intravenous analgesia should be considered in all cases 5.
- Nasal packing can be simplified using three types of packs that work in virtually every situation, including nasal sponge tampons, double-balloon nasal catheters, and anterior gauze with posterior Foley catheters 5.