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What is the most common source of epistaxis in individuals?
Which type of epistaxis is usually more profuse and often arterial in nature?
What is a potential complication associated with posterior epistaxis?
Which statement best describes the clinical presentation of anterior epistaxis?
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Which arteries contribute to the vascular supply of the Kiesselbach plexus?
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What percentage of epistaxis cases typically occur anteriorly?
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Which of the following is a characteristic feature of venous bleeds in epistaxis?
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What is the primary reason most nosebleeds do not result in a medical report?
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What is the preferred method to initially control epistaxis before seeking further treatment?
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Which of the following is NOT a common cause of epistaxis?
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What should be done if epistaxis is not controlled after 15 minutes of manual pressure?
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Why should older adults be particularly monitored for epistaxis?
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Which of the following treatment options is recommended for an acute episode of epistaxis?
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What is a crucial teaching point to prevent further episodes of epistaxis?
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What is the most common cause of nosebleeds?
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What indicates that epistaxis requires urgent referral to an ENT specialist?
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Which of the following should be avoided during recovery from epistaxis?
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Which groups are most likely to experience epistaxis?
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What is the purpose of a CBC in the context of substantial or recurring nosebleeds?
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Which local cause is NOT typically associated with epistaxis?
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In what circumstance would a Type and Cross test be indicated for a nosebleed patient?
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Study Notes
Epistaxis
- Epistaxis is a common complaint and often benign
- Most nosebleeds are self-limiting and spontaneous, some are recurrent
- Epistaxis is divided into two categories: anterior bleeds and posterior bleeds
- Anterior bleeds are more common (over 90%) and arise from Little’s area on the septum
- Posterior bleeds arise in the back of the nasal cavity, are usually more profuse, and are often of arterial origin
- Posterior bleeds present a greater risk of airway compromise, aspiration of blood, and greater difficulty controlling bleeding
Pathophysiology
- Bleeding typically occurs when nasal mucosa is eroded and vessels become exposed and break
- The Kiesselbach plexus is located on the septum, where vessels from the internal carotid artery (ICA - anterior and posterior ethmoidal arteries) and the external carotid artery (ECA - sphenopalatine and branches of the internal maxillary arteries) converge
- Anterior bleeds often have a capillary or venous origin and ooze, rather than the profuse pumping of blood observed with an arterial origin
- Posterior bleeds likely originate from branches of the sphenopalatine artery
Contributing Factors
- 90% of epistaxis is due to spontaneous rupture of blood vessels in the Kiesselbach plexus
- Systemic causes include arteriolosclerosis, hematological disorders, and hereditary hemorrhagic telangiectasias
- Local causes include trauma, irritants (e.g., smoking), inflammation of the nasal mucosa, a septal defect, intranasal foreign bodies, paranasal tumors, medications like NSAIDS, anticoagulants, and antiplatelets
- 10% of nosebleeds are idiopathic
- Epistaxis is more frequent in young children and elderly persons, and in males compared to females
Signs and Symptoms
- Most epistaxis has no signs or symptoms other than external bleeding or blood dripping down the posterior nasopharynx
Diagnostic Testing
- No laboratory studies are indicated for minor and nonrecurring nosebleeds
- For substantial or recurring nosebleeds, CBC, including platelet count, bleeding time, prothrombin time, and partial thromboplastin time may be helpful
- INR may be needed for patients on Coumadin
- Type and Cross may be needed for patients anticipated to need a blood transfusion due to blood loss
Differential Diagnosis
- Trauma
- Inflammation due to rhinitis or infection
- Vascular disorders
- Clotting disorders and blood dyscrasias
- Intranasal foreign bodies
- Hereditary telangiectasia
- Tumors
Treatment
- Most episodes of epistaxis are mild and self-limited and resolve spontaneously
- Control can be achieved by pinching the nostrils together for 5-10 minutes, keeping the patient in an erect position with the head tilted forward
- Anterior bleeds not controlled by manual pressure may be controlled with two sprays of Oxymetazolone 0.05% applied directly to the bleeding site followed by 10-15 minutes of manual pressure
- Nares may be packed, if necessary
- Have suction available
When to Refer to ENT
- Bleeding not controlled after 15 minutes of compression
- Evidence of massive bleeding
- Recurrent bleeding within the first hour
- Second episode of epistaxis within 1 week
- Uncontrolled bleeding from the posterior nasopharynx
Patient Teaching
- Avoid NSAID use
- Sneeze with the mouth open
- Avoid hot and spicy foods
- Do not pick at nose
- Avoid hot showers
Considerations for the Geriatric Population
- Patients older than 50 years often have more serious bleeding that requires medical attention
- Anemia can be a complication of frequent or excessive bouts of epistaxis
- Severe blood loss can exacerbate existing diseases
- Assess older patients for dyspnea, chest pain/pressure, and syncope
- Epistaxis in older adults can be a sign of arterial hypertension, cardiovascular disease, or a coagulation disorder
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Description
This quiz covers the common condition of epistaxis, commonly known as nosebleeds. It highlights the distinction between anterior and posterior bleeds, their origins, and relevant pathophysiology. Test your knowledge on the causes and management of this condition.
