# Epistaxis Management

## Overview

This module describes how to

manage epistaxis

manage epistaxis

Beyond the bleeding nose is a patient who may have other pathology causing the epistaxis e.g. hypertensive urgency or emergency, patients on warfarin with a raised INR, patients with TB and a thrombocytopaenia. These patients need other therapy in addition to the management of the epistaxis.

that does not resolve with direct pressure.

## Indications

## Contraindications

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“I’m going to try different ways to stop your nose bleeding.”

### What can my patient expect?

“We will first try to stop the bleeding by pinching your nose for 15 minutes. If it doesn’t work, I will try to find the bleed and stop it with a chemical. This will be uncomfortable, but it will not burn you. If I can’t stop the bleed this way, I will need to pack your nose tightly with gauze and perhaps even a small balloon. This will be very uncomfortable for you, but this kind of bleed must be stopped. You may need to stay in hospital overnight.”

### What is my patient’s role?

“Tell me if you have any allergies, take blood thinners, or have

medical conditions

medical conditions

Patients with renal failure, liver failure, inherited coagulopathies or disseminated intravascular coagulation should be referred to an ENT specialist in addition to the physicians that manage the respective conditions.

. Let me know if you have severe pain or dizziness at any point.”

## Preparation

Prepare a trolley with equipment.

### Documentation

### Equipment

## Site & Positioning

Position the patient sitting upright.

Most epistaxis originates in the anterior nasal cavity, and most anterior epistaxis originates from Kiesselbach’s plexus.

## Procedure

Follow medical asepsis with non-sterile gloves.

## Troubleshooting

The patient is uncooperative.

Try to reassure the patient, and explain why this is necessary. You may need an assistant to help with restraining.

I don’t have access to a Rapid Rhino and the patient is still bleeding.

Remove the anterior pack. Place a

posterior pack

posterior pack

Some evidence suggests that posterior packing does not tamponade bleeding, but may act as a support to improve the anterior pack. Packing the nose tightly with BIPP or Rapid Rhino should eliminate the need for a posterior pack.

by feeding a Foley catheter through the nostril until it is visible in the oropharynx. To avoid gagging, advance no further. Inflate the balloon with 5 ml of water, then retract it until it is firmly wedged in the posterior nose. Inflate with another 5 ml water. Wrap the catheter in gauze where it exits the nose and secure it to the face with tape. Subsequently, place an anterior pack.

## Risks

## References