Highlights & Basics
- Epistaxis (nosebleed) is a common condition with a bimodal age distribution, occurring more frequently in the young and the old.
- 90% arise at Little's area of the anterior septum, the location of the Kiesselbach plexus.
- Precipitating factors include dry weather and other causes of nasal mucosal inflammation or hyperemia, such as allergy, viral rhinitis, bacterial rhinosinusitis, dust, or chemicals. Although rare, neoplasm may also cause nosebleed.
- Topical anesthesia and vasoconstriction are essential for initial treatment of active bleeding. If initial measures fail, almost all episodes may be controlled with anterior or anterior-posterior packing techniques.
- Bleeding may be refractory in the presence of coagulopathy.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Nasal vasculature demonstrating the vessels that form the Kiesselbach plexus
Nasal pledgets for application of decongestant and local anesthetic
Expanding nasal sponge tampons
Expanding nasal sponge pack in place
Deflated and inflated double-balloon nasal catheter
Double-balloon nasal catheter in place
Anterior-posterior traditional Foley catheter-gauze pack
Diagram of bleeding sites in nose to accompany written patient information
Citations
Tan L, Calhoun K. Epistaxis. Med Clin North Am. 1999 Jan;83(1):43-56.[Abstract]
Perretta L, Denslow B, Brown C. Emergency evaluation and management of epistaxis. Emerg Med Clin North Am. 1987 May;5(2):265-77.[Abstract]
Santos P, Lepore M. Epistaxis. In: Bailey B, Healy G, Johnson J, et al., eds. Head & neck surgery-otolaryngology. Philadelphia: Lippincott, Williams & Wilkins; 2001:415-28.
Massick D, Tobin E. Epistaxis. In: Cummings C, Flint P, Harker L, et al., eds. Otolaryngology-head and neck surgery. Philadelphia: Elsevier Mosby; 2005:942-61.
Santos P, Lepore M. Epistaxis. In: Bailey B, Healy G, Johnson J, et al., eds. Head & neck surgery-otolaryngology. Philadelphia: Lippincott, Williams & Wilkins; 2001:415-428.
Massick D, Tobin E. Epistaxis. In: Cummings C, Flint P, Harker L, et al., eds. Otolaryngology-head and neck surgery. Philadelphia: Elsevier Mosby; 2005:942-961.
Tunkel DE, Anne S, Payne SC, et al. Clinical practice guideline: nosebleed (epistaxis). Otolaryngol Head Neck Surg. 2020 Jan;162(1 suppl):S1-S38.[Abstract][Full Text]
Pond F, Sizeland A. Epistaxis: strategies for management. Aust Fam Physician. 2000 Oct;29(10):933-8.[Abstract]
Randall DA. Epistaxis packing. Practical pointers for nosebleed control. Postgrad Med. 2006 Jun-Jul;119(1):77-82.[Abstract]
Ruddy J, Proops DW, Pearman K, et al. Management of epistaxis in children. Int J Paediatr Otorhinolaryngol. 1991 Apr;21(2):139-42.[Abstract]
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2. Perretta L, Denslow B, Brown C. Emergency evaluation and management of epistaxis. Emerg Med Clin North Am. 1987 May;5(2):265-77.[Abstract]
3. Santos P, Lepore M. Epistaxis. In: Bailey B, Healy G, Johnson J, et al., eds. Head & neck surgery-otolaryngology. Philadelphia: Lippincott, Williams & Wilkins; 2001:415-28.
4. Massick D, Tobin E. Epistaxis. In: Cummings C, Flint P, Harker L, et al., eds. Otolaryngology-head and neck surgery. Philadelphia: Elsevier Mosby; 2005:942-61.
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6. Massick D, Tobin E. Epistaxis. In: Cummings C, Flint P, Harker L, et al., eds. Otolaryngology-head and neck surgery. Philadelphia: Elsevier Mosby; 2005:942-961.
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