This refers to bleeding from the nose.

CAUSES

The commonest cause is picking of the nose, especially when there is an upper respiratory tract infection. It may also occur as part of generalized bleeding disorders mentioned under Haemostatic and bleeding disorders. Other causes are trauma, nasopharyngeal neoplasms and hypertension.

INVESTIGATIONS

If the epistaxis is due to nose-picking or nasal infection then investigations are not necessary.

TREATMENT

Therapeutic objective

• To stop epistaxis and prevent recurrence.

Non-Pharmacological Treatment

• Sit patient up and flex head to prevent blood running down throat
• Pinch soft side of nose for 10 minutes (patient must breathe through mouth)
• Apply ice-pack to nose

The above measures will usually arrest bleeding but if they fail, pharmacological treatment may be helpful.

Pharmacological Treatment

(Evidence rating: C)

• Topical application of 1:1000 solution of adrenaline on cotton wool
• If bleeding persists, the anterior nares should be packed with ribbon gauze saturated in sterile liquid paraffin

REFER

Patients with:

• Recurrent or severe epistaxis.
• Epistaxis which cannot be arrested.
• Epistaxis suspected to be due to causes other than nose picking or nasal infection.