This document discusses epistaxis, or nosebleeds. It notes that epistaxis is common, occurring in up to 60% of the population, though rarely causes massive bleeding or death. Nosebleeds can originate from the anterior or posterior nasal cavity. Common causes include trauma, medications, chronic sinusitis, and systemic factors like hypertension. Treatment involves applying pressure to the nose to promote clotting. If simple pressure fails, nasal packing may be needed. Packing is done either anteriorly or posteriorly depending on the bleeding site. Other treatments include cauterization, lasers, or embolization. Prevention focuses on maintaining nasal moisture and avoiding nose picking or heavy lifting.

1. By dr yasser mandour
Epistaxis

2. Background
Epistaxis is another name for what is commonly
known as nose-bleeds
It is an acute hemorrhage from the nostril, nasal
cavity, or nasopharynx
Common ED complaint, but 90% of patients can be
treated with
Occurs up to 60% of general population, but rarely
leads to massive bleeding and death

3. Where does it happen?
• Two sources
•Anterior (more
common)
•Posterior
(typically
common among
old patients)

4. Causes
Many different causes – locally, systemically, and
environmentally
Environmental causes include allergens and
humidity
Can also be idiopathtic

5. Common local causes
Chronic sinusitis
Epistaxis digitorum (nose picking)
Foreign bodies
Intranasal neoplasm or polyps
Irritants
Medications
Rhinitis
Trauma

6. Common systemic factors
Hemophilia
Hypertension
Leukemia
Liver disease (e.g., cirrhosis)
Medications
Platelet dysfunction/Thrombocytopenia

7. Treatment
Flow of blood normally stops when the blood clots
To encourage blood clotting
- Pinch the upper fleshy part of nose
- Do so for 5-20 minutes
- Tilt head forward can decrease the chance of nausea
and airway obstruction from swallowing blood
- Vasoconstrictive agents can also be used
- Other products available to promote coagulation

8. Packing when simple treatment
fails for anterior bleeding
•Anterior nasal
cavity is packed
from posterior to
anterior with
ribbon gauze that
has petroleum jelly
•Bayonet forceps
and a nasal
speculum can be
used to
approximate
accordion folding of
gauze
•Each layer should
be pressed down
firmly before next
layer is added
Bayonet forceps
Nasal speculum

9. Packing for posterior epitasis
• Done by
Otolaryngologist
•A catheter is
passed through the
nostril and through
the nasopharynx
and out the mouth
•A gauze pack is at
the end of the
catheter
•The gauze pack is
guide through the
mouth and into the
posterior nasal
cavity

10. Other treatments
Balloon packing
Cauterization of blood vessel
Laser therapy
Embolization

11. Prevention
Cooler house
Vaporizer to return
humidity and
moisture to the air
Nasal saline spray
and water soluable
jelly (especially for
winter months)
Avoid picking the nose
or blowing the nose
too vigorously.
Do not strain to bend
down or lift anything
too heavy.