Management

Management

• most patients can be treated as outpatients
• hospital admission may be necessary for;
  • elderly patients
  • posterior bleeding
  • coagulopathy
  • complicating comorbid conditions such as
    • coronary artery disease, severe hypertension, severe anaemia
    • a complete epistaxis tray should always be kept ready. Contents of an epistaxis tray include:
• nasal decongestant sprays
• local anaesthetics
• silver nitrate cautery sticks
• bayonet forceps
• nasal speculum
• Frazier suction tip
• posterior double balloon system and syringe for balloon inflation
• packing materials
• suction cautery

General measures include:

• monitoring vital signs - blood pressure, pulse rate
• maintaining a patent airway
• maintain haemodynamic stability
• intravenous infusion
• review of medication, especially anticoagulants
• taking blood for full blood count, group and save, cross-match, coagulation studies

In haemodynamically stable patients, consider the following to stop bleeding

• first aid measures
• cautery - used in epistaxis that is refractory to first aid measures and if the bleeding site can be identified
• nasal packing - if bleeding continues despite cautery methods or if the bleeding point cannot be seen
• if nasal packing fails refer the patient to secondary care for further management

Reference

1. National ENT Trainee Research Network. The British Rhinological Society multidisciplinary consensus recommendations on the hospital management of epistaxis. J Laryngol Otol. 2017 Dec;131(12):1142-56.