EN4.28 | Epistaxis — Summary & Reflection

KEY TAKEAWAYS

Epistaxis is classified as anterior (90%, from Little's area/Kiesselbach's plexus on the anteroinferior septum — five vessels including the anterior/posterior ethmoidal arteries and sphenopalatine/greater palatine/superior labial branches) or posterior (10%, from sphenopalatine artery territory or Woodruff's plexus — elderly, hypertensive, runs down throat, bilateral). Local causes include digital trauma (commonest in children), DNS/spur, foreign body, JNA (DO NOT BIOPSY — adolescent male + epistaxis + nasal obstruction = contrast CT first), and tumour. Systemic causes include hypertension (sustains the bleed), anticoagulants (warfarin, DOACs, aspirin), coagulopathies, dengue, and HHT. First aid: sit upright + lean forward + pinch the soft nose for 10–15 minutes — NEVER tilt head back. Escalation: chemical cauterisation → BIPP/Merocel anterior pack → posterior balloon pack → endoscopic sphenopalatine artery ligation (ESPAL). Never cauterise both sides of the septum at the same level (risk of septal perforation). Control blood pressure and reverse anticoagulation in posterior bleeds.

REFLECT

Think about the last time you saw a nosebleed being managed — in an emergency department, a clinic, or even in your own family. Was the head tilted back? Was anterior pinching applied in the correct place (soft cartilaginous nose, not the bony nasal bridge)? Were the systemic factors (blood pressure, medications) assessed? Epistaxis is one of those conditions where the correct first-aid action seems obvious but is frequently done wrongly. Commit the three rules to memory: sit forward, pinch soft, hold 15 minutes. These rules will stop most anterior bleeds and will save you from causing aspiration in a patient who is already frightened and bleeding.