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Epistaxis

Christopher R Heron, Bachelors of Science - Biology, Biochemistry & Biophysics, Doctor of Medicine and Ryan Kipp, Bachelor of Science (B.S.) in Biology, Doctor of Medicine (M.D.) Reviewed 06/2022
 


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 for symptoms of anemia and cardiovascular compromise.

  • Determine the side on which bleeding began, as well as its severity and duration.

  • Define trauma (including nose picking) and...

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
Tunkel DE, Anne S, Payne SC, et al. Clinical Practice Guideline: Nosebleed (Epistaxis) Executive Summary. Otolaryngol Head Neck Surg. 2020 Jan;162(1):8-25. 
2
Biggs  T...

CODES

ICD10

R04.0 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 digital trauma (nose picking...

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