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Epistaxis, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Nosebleeds are a common emergency presentation that is usually minor and self-limited but rarely may be life threatening:

    • Lifetime incidence of ∼60%:

      • The incidence decreases with age, ...

Diagnosis

Signs and Symptoms

History

  • Laterality of the bleeding

  • Intensity and amount of bleeding from the nares

  • Recurrence of epistaxis and history of prior episodes

  • Nasal obstruction and the duration of t...

Treatment

Pre-Hospital

  • Stable patients: Patient should bend forward at the waist; pinch nares closed, and spit out blood rather than swallow it.

  • Unstable patients:

    • Intubation, if airway is compromised

    • IV ...

Follow-Up

Disposition

Admission Criteria

  • Severe blood loss requiring transfusion

  • Severe coagulopathy that places the patient at risk of further blood loss

  • Posterior nasal packing: Otolaryngology consult a...

Pearls and Pitfalls

  • Foreign bodies should be suspected in any unilateral nasal bleeding in small children, psychiatric patients, and patients with mental retardation.

  • Avoid covering anterior nasal ball...

Additional Reading

  • Barnes  ML, Spielmann  PM, White  PS. Epistaxis: A contemporary evidence based approach. Otolaryngol Clin North Am.  2012;45(5):1005–1017.

  • Lewis,  TJ. Epistaxis. In: Wolfson  AB...

Codes

ICD9

784.7 Epistaxis 

ICD10

R04.0 Epistaxis 

SNOMED

  • 12441001 Epistaxis (disorder)

  • 232354002 Anterior epistaxis

  • 232355001 Posterior epistaxis

  • 232356000 Traumatic epistaxis

  • 232357009 Post-surgical epistaxi...

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