Goals

To achieve hemostasis, identify local or systemic causes, and prevent recurrent episodes of bleeding.

Background

Most cases of epistaxis occur before the age of 10 or between 45 and 65 years. Ninety percent of bleeds are from the anterior nasal septum from the area known as Kiesselbach’s plexus. Kiesselbach’s plexus includes vessels originating from the anterior and posterior ethmoidal, superior labial, greater palatine, and sphenopalatine arteries (Hakim, Mummadi, Jolly, Dawson, & Darr, 2018). Anterior bleeds are often unilateral and are most commonly due to mucosal trauma or irritation. Posterior bleeds typically arise from Woodruff’s plexus which is formed by branches of the sphenopalatine and pharyngeal arteries (Hakim et al., 2018). Most anterior bleeds can be managed in primary care, whereas, posterior bleeds are often more severe and may require posterior packing or surgical intervention. Local and systemic causes epistaxis include mucosal trauma or irritation, infection, medication (systemic or local), tumours, vascular conditions, hypertension, platelet disorders, and clotting disorders.

Contraindications

Facial fracture with suspected or confirmed basilar skull fracture.