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Acute Epistaxis' (adults and children)

 

This guideline applies to children and adults. For an recurrent epistaxis please see guidelines on ‘Chronic Recurrent Epistaxis’


Useful resources for patients and HCP

https://www.entuk.org/patients/conditions/42/nosebleeds_epistaxis_update

 

Background

Epistaxis tends to affect the elderly, but is also very common in children. Over 50% aged 6-15yr old have nosebleeds regularly. Children under age of 2yr are likely to have an underlying cause for their nosebleeds.


Acute Epistaxis

 

Overview of management and referral pathways:

 

When to refer to MIU / ED

The following patients should be referred to MIU / ED:

  • Haemodynamically unstable
  • Epistaxis that does not respond to first aid measures AND cautery unavailable/unsuccessful

 

Nasal cautery

 

Consider if the following apply:

Before:

  • Ask patient to blow nose
  • Apply topical local anaesthetic spray, e.g. Co-phenylcaine, and wait 3-4 mins

During:

  • Identify the bleeding point (will look like a small red dot)
  • Lightly apply silver nitrate stick to bleeding point for 3-10 seconds until grey-white colour develops (only cauterise one side of the septum to avoid perforation)

After:

  • Dab cauterised area with clean cotton bud
  • Apply topical antiseptic preparation, e.g. Naseptin / mupirocin
  • Follow conservative management advice below

 

 

Conservative management

These measures should be employed whereby the patient is haemodynamically stable and bleeding has ceased, either using first aid measures or nasal cautery:

 

1) Self-care advice

Recommend that for 24 hours the patient should avoid the following activities as they may increase the risk of re-bleeding:

  • Blowing or picking the nose
  • Heavy lifting
  • Strenuous exercise
  • Lying flat
  • Drinking alcohol or hot drinks

 

2) Manage reversible causes

  • Consider short cessation of anticoagulation / anti-platelets if clinically appropriate

 

3) Topical antiseptic preparation

  • Naseptin cream- apply to nostrils QDS for 10 days.If compliance an issue, can use BD for up to 2 weeks
  • Mupirocin nasal ointment(alternative - if allergic to neomycin, peanut or soya) - apply to nostrils BD-TDS for 5-7 days

 

4) Chronic or recurrent acute epistaxis

 

 

References

https://www.entuk.org/patients/conditions/42/nosebleeds_epistaxis_update

https://cks.nice.org.uk/topics/epistaxis-nosebleeds/

 

 

Review Date                April 2022

Next Review Date        April 2023

GP Sifter                      Dr Laura Vines

Contributors                 Ms Aileen Lambert

                                     Mr Neil Tan

Version                        2.0