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EpistaxisAka: Nosebleed, Nasal bleeding
- See Also
- Pathophysiology
- See Nasal Anatomy
- Signs and symptoms
- Nasal bleeding
- Unilateral or Bilateral nares
- Posterior pharynx
- Retrograde into lacrimal duct (rarely)
- Hypertension
- Often labile
- Not sustained
- Nasal bleeding
- Causes
- Local (most common)
- Trauma
- Nose picking
- Dry air
- Irritants (e.g. Tobacco smoke, repeated Cocaine use)
- Topical medications (e.g. Intranasal Steroids)
- Nasal Foreign Body
- Forceful nose blowing
- Nasal surgery
- Intranasal polyp or neoplasm
- Systemic causes (uncommon)
- Bleeding Disorder
- See Bleeding Diathesis
- NSAIDs, Aspirin or anticoagulant use
- Hypertension (rarely causes epistaxis)
- Bleeding Disorder
- Local (most common)
- Labs
- Indications (rare)
- Bleeding occurs from multiple sites in nose
- Signs of coagulopathy
- Tests
- Complete Blood Count with platelets
- Prothrombin Time
- Partial Thromboplastin Time
- Indications (rare)
- Management: Anterior Hemorrhage
- Bleeding sites
- Kiesselbach's Plexus at septum most common site
- Anterior end of inferior turbinate also common
- Position patient leaning forward
- Keeps blood from collecting posteriorly
- Prevents Nausea and airway obstruction
- Apply manual pressure for 5-20 minutes
- Squeeze nose to apply pressure to septum
- Decongest Nasal mucosa
- Insert with long forceps and leave in for 20 minutes
- Cocaine soaked 2x2 gauze rolled or
- Oxymetazoline (Afrin) on cotton pledget (or spray)
- Lidocaine 2% and Phenylephrine 4% mix 1:1 on cotton
- Insert with long forceps and leave in for 20 minutes
- Exam basics
- Use good lighting
- Have irrigant and suction (Frazier tip) available
- Use Eye Protection and mask
- Localize and Cautery with Silver Nitrate
- Apply to localized bleeding source for 30 seconds
- Avoid repeated cautery
- Risk of septal perforation
- Do not use on both sides of septum
- Silver nitrate is equivalent to electrocautery
- Bleeding continues
- See Nasal Packing
- Bleeding sites
- Management: Persistent bleeding
- See Anterior Nasal Hemorrhage Management
- See Posterior Nasal Hemorrhage Management
- Known coagulopathy
- Desmopressin Spray (DDAVP)
- Intractable Bleeding
- Arterial ligation
- References
Epistaxis (C0014591) | |
|---|---|
| Definition (MSH) | Bleeding from the nose. |
| Definition (NCI) | Bleeding from the nose. |
| Concepts | Pathologic Function (T046) |
| ICD9 | 784.7 |
| Basque | SUDUR ODOLJARIOA/EPISTASIA |
| Danish | Naeseblod |
| Dutch | Epistaxis/neusbloeding |
| English | Bleeding from nose, Epistaxis, Finding of bleeding of nose, Hemorrhage from nose, HEMORRHAGE NASAL, NASAL BLEEDING, Nasal haemorrhage, Nasal Hemorrhage, Nose Bleed, Nose bleed/epistaxis, Nose Bleeds, Nosebleed, Observation of bleeding of nose |
| Finnish | NENAVERENVUOTO |
| French | Saignement de nez/epistaxis |
| German | Nasenbluten/Epistaxis |
| Hebrew | demem mehaaf |
| Hungarian | orrverzes/epistaxis |
| Italian | Sangue dal naso/epistassi |
| Norwegian | NESEBLODNING |
| Portuguese | Epistaxis/hemorragia nasal |
| Spanish | epistaxis, hemorragia de la nariz, hemorragia nasal, Hemorragia nasal/epistaxis, sangrado de la nariz, sangrado nasal |
| Swedish | NASBLODNING/EPISTAXIS |
| Parent Concepts | Hemorrhage (C0019080), Nose Diseases (C0028432), Disease of capillaries (C0155765), Physical findings (C0311392), [D]Head and neck symptoms NOS (C0476247), Symptoms and Complaints Component (C0497525), respiratory (C0521346), Respiratory tract hemorrhage (C0235560), Nasal cavity disease NOS (C0339820), Nose finding (C1269534), Duplicate concept (C1274013) |
| Sources | COSTAR, CST, DXP, ICD9CM, ICPC, ICPCBAQ, ICPCDAN, ICPCDUT, ICPCFIN, ICPCFRE, ICPCGER, ICPCHEB, ICPCHUN, ICPCITA, ICPCNOR, ICPCPOR, ICPCSPA, ICPCSWE, MSH, MTH, MTHICD9, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
