EPISTAXIS DEFINITION Epistaxis is bleeding from the nose

EPISTAXIS

DEFINITION Epistaxis is bleeding from the nose (nose bleed). It is common in children less than 10 years old as well as adults over the age of 50. Children and young adults have a tendency to develop anterior nasal bleeding, whereas older adults more commonly have posterior nasal bleeding. Anterior bleeding usually stops spontaneously or can be self-treated; posterior bleeding may require medical treatment.

Causes Trauma Foreign bodies Topical corticosteroids Allergic Rhinitis Tumours Any condition that prolongs bleeding time alters platelet count will predispose the patient to Epistaxis.

Bleeding time may also be prolonged if the patient takes Aspirin or NSAIDs. Hypertension increases the risk of Epistaxis and elevated blood pressure makes bleeding more difficult to control.

Management of Epistaxis First aid measures. Keep the patient quiet. Place the patient in a sitting position, leaning forward or if not possible in a high fowlers position. Apply direct pressure by pinching the entire soft lower portion of the nose for 10 -15 minutes.

Apply ice compresses to the nose. Partially insert a small gauze pad into the bleeding nostril, and apply digital pressure if bleeding continues. Obtain medical assistance if bleeding does not stop.

Medical management Identification of bleeding site and application of a vasoconstrictive agent, cauterization, or anterior packing by a health care provider. Anterior packing may consist of ribbon gauze impregnated with antibiotic ointment and/or vasoconstrictive agent such as Oxymetazoline or Cocaine that is wedged firmly to the desired location and remains

In situ for 48 -72 hours. If posterior packing is required, the patient is hospitalised. Inflatable balloons similar to a urinary catheter may be used as a nasal pack or gauze rolls may be inserted. Strings attached to the cheek for ease of removal.

A nasal sling in a folded 2 x 2 inch pad should be taped over the nares to absorb drainage.

Complications of nasal packing Respiratory status may be altered. There can be hypoventillation (increase in partial pressure of carbon dioxide in arterial blood) and hypoxaemia (decrease in partial pressure of Oxygen in arterial blood) which may lead to dysrythmias or respiratory arrest. Packing may predispose to infection.

Nasal packing is painful because sufficient pressure must be applied to stop bleeding. NB; Nasal pack is left in situ for a minimum 3 days. After removal, the nerves may be gently cleaned and lubricated with water soluble jelly. Failure of posterior packing – surgery (ligation of artery).

Patient Education (IEC) Avoid vigorous nose bleeding. The patient should avoid strenuous activity, lifting and straining for 4 -6 weeks. The patient is taught to sneeze with the mouth open and to avoid use of Aspirin products or NSAIDs.