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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. The remainder are posterior bleeds, most commonly from terminal branches of the anterior and posterior ethmoid arteries or the sphenopalatine artery.
- Precipitating factors include dry weather and other causes of nasal mucosal inflammation or hyperemia, such as allergy, viral rhinitis, bacterial rhinosinusitis, intranasal drug use, dust, or chemicals. Although rare, neoplasm may also cause nosebleeds.
- 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 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
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Seikaly H. Epistaxis. N Engl J Med. 2021 Mar 11;384(10):944-51.
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