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Epistaxis is a topic covered in the 5-Minute Emergency Consult.

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  • Nosebleeds are a common emergency presentation that is usually minor and self-limited but rarely may be life threatening:
    • Lifetime incidence of ∼60%:
      • The incidence decreases with age, with most cases seen in children <10 yr.
      • 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


  • Idiopathic:
    • Dry nasal mucosa (low humidity)
  • Nasal foreign body:
    • Children, mentally retarded patients, psychiatric patients
  • Infection:
    • Rhinitis
    • Sinusitis
    • Nasal diphtheria
    • Nasal mucormycosis
  • Allergic rhinitis
  • Trauma:
    • Nose picking
    • 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
    • Heparin
    • Coumadin
  • Hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu disease)
  • Atherosclerosis of nasal vasculature
  • Endometriosis

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Rosen, Peter, et al., editors. "Epistaxis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307436/all/Epistaxis.
Epistaxis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307436/all/Epistaxis. Accessed April 25, 2019.
Epistaxis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307436/all/Epistaxis
Epistaxis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307436/all/Epistaxis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Epistaxis ID - 307436 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307436/all/Epistaxis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -