Epistaxis
Bleeding through the nose, due to nose picking, trauma (fall in games, assault, etc.), nasal and paranasal neoplasms, nasal infection, systemic derangements,, e.g., acute fevers, hypertension, renal disease with uraemia, abnormalities of blood clotting, and foreign bodies in the nose.
Management
- Immediate: Sit the patient up (to avoid aspiration).;
- Pinch the nose for 10-20 minutes. This is usually sufficient to stop the bleeding.
- Apply ice or cold packs on the bridge of the nose.
- To pack the nose, remove clots as aspirates. Apply lignocaine nasal spray 4%, then pack (preferably using Tiley’s forceps) with ribbon gauze or narrow strip of gauze impregnated with liquid paraffin. Start packing from the floor of the nose towards the roof. The pack should fit tightly to be effective. Do not use adrenaline.
3.Remove paraffin packs within 24-48 hours.
Put a patient with a nasal pack on:
- Broad spectrum antimicrobial, e.g., cotrimoxazole or amoxicillin for 7 days.
- Analgesic, e.g., paracetamol 500mg 8 hourly for 5 days (children 40mg/kg/day QDS).
- Remove Paraffin Pack Within 24-48 Hours.
- Put a patient with a nasal pack on:
- Broad spectrum antimicrobial, e.g., cotrimoxazole or amoxicillin for 7 days.
- Analgesic, e.g., paracetamol 500mg 8 hourly for 5 days (children 40mg/kg/day QDS).
- Attend to primary cause. Patients may require inpatient treatment of the underlying causative factor. Treat the underlying cause and provide additional treatment with cautery or endoscopic therapies.
- Admit the patient if fluid replacement or blood transfusion is required.
- In an adult, the cause should be identified as epistaxis is a more sinister sign in adult. Rule out malignancy.