Hiba Iqbalover 3 years ago

Acute Epistaxis

Epistaxis is defined as acute hemorrhage from nostrils, nasal cavity or nasopharynx. It is common emergency department (ED) complaint but almost 90% patients recover by general treatment. Note the duration, severity of bleeding and site of initial onset. Inquire about any previous history of nosebleed, easy bruising (to check platelet disorders), hypertension or other systemic diseases. Use of medications especially aspirin, NSAIDS, warfarin, heparin and dipyridamole should be documented. Perform a thorough examination of nasal cavity. Approximately 90% of nosebleed are visualised in anterior nasal cavity. Blood dripping from posterior nasopharynx confirms a nasal source. Differential diagnosis include disseminated intravascular coagulation (DIC), rhinitis, sinusitis, cocaine toxicity, foreign bodies, hemophilia or von Willebrand disease (vWD). First of all assess ABC (Airway, Breathing, Circulation). Patient should be instructed to grasp or pinch their entire nose maintaining continuous pressure for 10 with head being slightly tilted downwards. Patients with significant lose should receive intravenous (IV) line and crystalloid infusion as well continuous cardiac monitoring and pulse oximetry.