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Epistaxis

Rebecca Wetzel, DO and Brian E. Neubauer, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Hemorrhage from the nose involving either the anterior or posterior mucosal surfaces

  • Intractable or refractory epistaxis: recurrent or persistent despite appropriate packing or multip...

DIAGNOSIS

HISTORY

  • Assess airway patency and cardiovascular stability.

  • Determine on which side bleeding began, anterior or posterior, duration.

  • Define trauma (including nose picking) or other precipitatin...

TREATMENT

  • Most cases are managed as outpatient (1)[B].

  • Home use—Nosebleed QR: a nonprescription powder of hydrophilic polymer with potassium salt; induces scab formation

  • Patient applies direct pressure ...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

  • Hemodynamic monitoring if severe blood loss

  • 24-Hour minimum for leaving packing in place; some recommend 3 to 5 days. Rebleed usually occurs betw...

REFERENCES

1
1 Melia L, McGarry GW. Epistaxis: update on management. Curr Opin Otolaryngol Head Neck Surg.  2011;19(1):30–35. {L-End} {L-End} [View Abstract on OvidMedline]
2
2 Biggs TC, Nighting...

ADDITIONAL READING

  • Manes RP. Evaluating and managing the patient with nosebleeds. Med Clin North Am.  2010;94(5):903–912. {L-End} {L-End} [View Abstract on OvidMedline]

  • Schlosser RJ. Clinical p...

CODES

ICD10

R04.0 Epistaxis 

ICD9

784.7 Epistaxis 

SNOMED

  • 12441001 Epistaxis (disorder)

  • 232354002 Anterior epistaxis

  • 232355001 Posterior epistaxis

  • 232356000 Traumatic epistaxis

CLINICAL PEARLS

  • Most epistaxis is anterior and responds well to timed pressure over the anterior nares for 5 to 20 minutes.

  • Most nosebleeds are idiopathic or as a result of nose picking.

  • Posterior noseb...

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