Epistaxis

Condition

• Epistaxis 

Causes (Adapted from General Practice by John Murtagh)

• Local causes
• idiopathic
• intracranial tumours
• Rhinitis
• Trauma including nose picking
• URTI
• Common cold
• influenza
• Sinusitis
• Systemic causes
• Blood disorders
• Cardiovascular disorders
• arteriosclerosis
• hypertension
• Drugs: anticoagulants, aspirin, others
• Hereditary haemorrhagic telangiectasia
• Systemic febrile infections
• Toxic agents

History

• Establish volume of blood loss e.g. duration
• Try to identify cause e.g. medications, trauma, common cold, rhinitis, drug and alcohol and any other sources of bleeding
• Try to differentiate between anterior and posterior bleed

Examination

• Good light, suction and speculum with local decongestant and anaesthetic spray ready

Other diagnoses to consider 

• Hereditary haemorrhagic telangiectasia 2-4/100 000. Inherited disorder through an autosomally dominant gene. 
• A young male patient with recurrent significant nosebleeds should be investigated for juvenile angiofibroma

Treatment

• Minor bleed: kenacomb ointment 
• Severe bleed --> ED

References:

- General practice by John Murtagh

- RACGP Check program ENT 2011 Case 5