EPISTAXIS
Description
Epistaxis is a clinical term for nose bleed, that usually occurs when the blood drains out of the nostrils. It occurs as either
1. Anterior epistaxis or
2. Posterior epistaxis
Anterior epistaxis is the most common form observed. The anterior (front) part of the nose is rich in blood vessels. Minor injuries that affect the nose allow the blood to drain out and is not considered a medical emergency. Bleeding farther back in the nose is known as a posterior epistaxis. Posterior bleeds are often prolonged and difficult to control. They can be associated with bleeding from both nostrils and with a greater flow of blood into the mouth. Posterior bleeds require medical attention but are rarely fatal. About 60% of people have
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Bleeding from the nose and mouth
2. Shock due to excessive loss of blood
Diagnosis
Diagnosis is done with the help of observed symptoms.
Treatment
The treatment of epistaxis depends on a number of factors such as
1. Type and severity of bleeding.
2. Condition of the patient.
3. Identification of a local or systemic cause for the bleeding.
In cases with active epistaxis, check the vitals and apply firm pressure below the nasal bone. If bleeding does not stop after 15 minutes, then refer to an otolaryngologist for nasal cautery. Patient should be admitted in the hospital for nasal cautery. If nasal cautery is not able to stop bleeding, then nasal packing (anterior, posterior, merocel) is suggested.
If bleeding is still not controlled, arterial ligation, angiography and embolization may be required.
Simultaneous treatment of the underlying cause is carried out.
References
1. Epistaxis. In: Scott Brown’s Otolaryngology. Booth JB (ed) Vol 2, 7th Edition, 2008; 1596-1607.
2. Epistaxis. In: Cummings Otolaryngology, Vol. 2, 4th Edition