Contributor: Dylan Luyten, MD

Educational Pearls:

• Clear the nasal passages - have the patient, if stable, blow their nose to dislodge any clot that might be in the way
• Searching for the source of bleeding can be tough. Majority of anterior bleeding is from Kesselbach's plexus
• Placing a clamp to provide direct pressure is a mainstay of treatment
• Application of a topical agent, which may include lidocaine epinephrine tetracaine (LET), tranexamic acid (TXA), or oxymetazoline
• Nasal packing with a nasal balloon or merocel may be necessary if bleeding persists
• Posterior epistaxis can be potentially devastating - for all practical purposes are epistaxis that does not resolve with anterior packing
• Interventional radiology can be a helpful consultant for controlling of posterior epistaxis, and may be just as or more helpful than ENT

References

Supriya M, Shakeel M, Veitch D, Ah-See K. Epistaxis: prospective evaluation of bleeding site and its impact on patient outcome. J Laryngol Otol. 2010;124(7):744-749.

Shargorodsky J, Bleier B, Holbrook E, et al. Outcomes analysis in epistaxis management: development of a therapeutic algorithm. Otolaryngol Head Neck Surg. 2013;149(3):390-398.

Singer A, Blanda M, Cronin K, et al. Comparison of nasal tampons for the treatment of epistaxis in the emergency department: a randomized controlled trial. Ann Emerg Med. 2005;45(2):134-139.

Womack JP, Kropa J Jimenez Stabile M. Epistaxis: Outpatient Management. Am Fam Physician. 2018 Aug 15;98(4):240-245.

Liu WH, Chen YH, Hsieh CT, Lin EY, Chung TT, Ju DT. Transarterial embolization in the management of life-threatening hemorrhage after maxillofacial trauma: a case report and review of literature. Am J Emerg Med. 2008 May;26(4):516.e3-5. doi: 10.1016/j.ajem.2007.07.036.

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD