Investigations

Examination of the nasal passage should be done with a nasal speculum under adequate lighting to identify bleeding points (1)

• if a blood clot is present, advice the patient to blow their nose (with caution) or it can be removed using suction (1)
• topical sprays containing a combination of anaesthetics and vasoconstrictors can be used to control bleeding in order to carry out an adequate physical examination (2)

Laboratory studies are indicated in:

• patients with severe haemorrhage - full blood count, coagulation studies, blood typing and screening for possible transfusion
• patients taking warfarin - full blood count, coagulation studies
• patients with systemic conditions - investigations for hepatic or renal dysfunction (2)

Note - blood tests should not be ordered routinely in simple cases of epistaxis (3)

Reference:

1. Aneeshkumar MK et al. Look before you pack: key point in epistaxis management. Emerg Med J. 2005;22(12):912-3
2. Schlosser RJ. Clinical practice. Epistaxis. N Engl J Med. 2009;360(8):784-9
3. 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.