Epistaxis
Basics
Basics
Basics
Description
Description
- Nosebleeds are a common emergency presentation accounting for 1 in 200 ED visits
- Usually minor and self-limited but rarely may be life threatening:
- Lifetime incidence of ∼60%:
- Bimodal age distribution with one peak <10 and one peak between the age of 70–79
- Posterior epistaxis more common in the elderly
- Male > female
- Severe bleeds requiring surgical intervention are more common in patients >50 yr
- Occurs more frequently with low humidity during the winter, in northern climates, and at high altitude
- The nasal cavity is supplied with blood vessels originating from both the internal and external carotid arteries
- Location of the hemorrhage determines therapy:
- Anterior epistaxis (90% of cases): Bleeding can be visualized in anterior nose
- Most commonly bleeding is located at Kiesselbach plexus, an anastomotic network of vessels on the anteroinferior nasal septum
- Rarely, bleeding is found on the posterior floor of the nasal cavity or the nasal septum
- Posterior epistaxis (10% of cases): Bleeding source not within range of direct visualization
- Posterolateral branch of sphenopalatine artery
Etiology
Etiology
- Idiopathic:
- Dry nasal mucosa (low humidity)
- Nasal foreign body:
- Children, mentally retarded patients, psychiatric patients
- Infection:
- Rhinosinusitis
- Nasal diphtheria
- Nasal mucormycosis
- Allergic rhinitis
- Trauma:
- Nose picking (most common in children)
- Postoperative
- Facial trauma
- Barotrauma
- Environmental irritants:
- Ammonia
- Gasoline
- Sulfuric acid
- Glutaraldehyde
- Intranasal neoplasia: Most commonly papilloma
- Coagulopathy:
- Hemophilia A or B
- von Willebrand disease
- Thrombocytopenia: Liver disease, leukemia, chemotherapy viral illness, or autoimmune disease
- Platelet dysfunction: Renal impairment or chronic alcohol consumption
- Drug induced:
- Salicylates
- NSAIDs
- Anticoagulant medications
- Hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu disease)
- Atherosclerosis of nasal vasculature
- Endometriosis
- Iatrogenic:
- Nasogastric tube insertion
- Nasotracheal intubation
- Nasal airway placement
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