Podcast #117: Epistaxis

8999d8b2-b165-40cb-a215-09e30b2c98bdRun Time: 3 minutes

Author: Michael Hunt M.D.

Educational Pearls:

  • Epistaxis accounts for a 1-2% incidence of all ER visits, approximately 450,00 patients per year are seen in the Emergency Room with epistaxis.
  • Anatomically categorized into 2 realms: Anterior: when you can see the source of the bleed after clearing the nose, and posterior: when the source of the bleed cannot be seen once the nose is cleared.
  • There are arterioles that come into the septum at Kiesselbach’s plexus, which accounts for 95% of anterior nosebleeds. 
  • Nosebleeds are almost always on 1 sided, although they can work up and over the septum if there is a large amount of bleeding. 
  • The first thing that a patient should do when they get a nosebleed is hold the nose right below the nasal bone and squeeze for 10 minutes. If that does not stop then the patient should seek treatment in the Emergency Room.
  • If pressure, and silver nitrate does not work then the patient will get their nose packed. Anterior packs have 1 balloon and posterior packs require 2 balloons and have the potential to repress respiratory drive in older patients causing hypoxia.
  • Literature suggests that antibiotics are not necessary when a patient gets a nasal packing, this avoids complications like diarrhea, allergic reactions, and C. diff infection.

Link to Podcast: http://medicalminute.madewithopinion.com/epistaxis/

References: http://www.hindawi.com/journals/ijoto/2015/283854/

Categories ENT

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