Epistaxis Management


Initial Management:

1. Positioning: Advise the patient to lean forward, open their mouth, and press the soft part of their nose for 10-15 minutes.

2. Goal: Apply pressure to the bleeding vessel and allow blood to exit through the nose rather than going down the throat.


Nasal Cautery:

. Indication: Use if the bleeding does not stop with pressure.

. Method: Nasal cautery with silver nitrate.

. Precaution: Avoid cautery if there is active bleeding as the silver nitrate will be washed out.


Nasal Packing:

. Indication: Use if cautery is unsuccessful or if there is active bleeding.
. Method: Insert gauze or a nasal sponge into the nostrils to apply pressure on the bleeding vessel.
. Duration: Typically left in for 24-48 hours.


Recurrent Epistaxis with No Active Bleeding:

. Observation: Recurrent episodes with visible blood vessels on the anteroinferior part of the nasal septum bilaterally.

. Management:

. First-line: Nasal cautery at one side of the septum initially.

. Alternative: Topical treatment with Naseptin (Chlorhexidine and Neomycin cream).

. Note: Both sides may eventually need cautery, but not simultaneously to avoid septal perforation.


Recurrent Epistaxis with Active Bleeding:

. Observation: Visible blood vessels on the anteroinferior part of the nasal septum bilaterally with active bleeding.

. Management:

. First-line: Anterior nasal packing bilaterally.

. Precaution: Even if the bleeding point is not visible, anterior nasal packing is indicated for active bilateral bleeding.

. Note: Cautery should be avoided if there is active bleeding.


Key Points:

i. Always avoid bilateral simultaneous cautery due to the risk of septal perforation.

ii. Ensure proper follow-up and monitoring, especially in cases of recurrent or severe epistaxis.

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