What is the Best Management for Geriatric Epistaxis? A Comprehensive Systematic Review and Meta-analysis (original) (raw)
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Aetiology and Management of Epistaxis -A Prospective Clinical Study
Objective : Epistaxis is a common clinical problem and is an uncomfortable experience that can cause great apprehension and anxiety in patients. Most nose bleed are benign, spontaneous and self-limiting. Epistaxis can range from minor bleed o profuse bleed that can be life threatening and warrant urgent medical attention. By this means it becomes necessary to study aetiology, age and sex incidence, seasonal variation, site and management of epistaxis. Methods : This prospective study was carried out in Department of Otorhinolaryngology, School of Medical Sciences and Research, Greater Noida from January 2013 to June 2014. The study subjects included 100 patients who presented with epistaxis during the period under study. Results : The mean age of patients were 30.44±19.08 (SD) years and male to female ratio was 3:1. Epistaxis was more common during hot dry months and dry cold winter months. Trauma to the nose caused epistaxis in 35% of case. Neoplasms of nose, paranasal sinuses and nasopharynx were observed to be responsible for epistaxis in 13% of cases. Acute and chronic inflammatory conditions of nose were responsible for epistaxis in 13% of cases. High blood pressure was found in 10% of cases. In 7% of the cases, epistaxis was idiopathic. Anterior bleed was present in 69% of cases while posterior nasal bleed was seen in 34% of cases, in 12% cases site is undetermined. Conclusion : 79% cases treated successfully with conservative approach while 21% cases required surgical intervention. In this study conservative treatment was found effective in most cases.
Management of epistaxis in general practice
Australian family physician, 2002
The vast majority of cases of epistaxis can be managed successfully within general practice. To describe a range of clinical interventions in the management of epistaxis appropriate to general practice. A number of relatively simple treatments and procedures may provide relief for anterior nasal bleeding, which is the site for over 80% of cases of epistaxis. Where more procedural interventions are necessary, adequate preparation and appropriate tools are required to perform these processes safely. Initial identification of the site of bleeding before commencement of treatment may be difficult but allows the correct treatment to be applied with minimal discomfort to the patient. More copious bleeding which constitutes less than 5-10% of cases, is usually the result of posterior nasal bleeding and is best treated in a facility well set up to handle such an eventuality. In cases of chronic epistaxis, a number of interventions, medical and surgical have been trialled with variable succe...
An Aetiopathological Study on Epistaxis in Adults and its Management
Bengal Journal of Otolaryngology and Head Neck Surgery
IntroductionEpistaxis is a common clinical problem in ENT practice. Idiopathic aetiology is said to be the most common.Aim of studyTo find out whether idiopathic epistaxis is the most common cause of primary adulthood epistaxis and to formulate the best treatment protocolMaterials & MethodsA prospective study was conducted in a tertiary healthcare setup from August 2013 to August 2014. 100 patients of more than 16 years of age of both sexes were studied. Patients presenting with active nasal bleeding in ENT ER and OPD were included.ResultsTruly idiopathic epistaxis was encountered in 37% of the study population followed by 20% cases in association with grossly deviated septum with septal spur(s). Most of the cases were managed by resuscitation alone with or without anterior nasal packing. Conclusion: With advances in endoscopy & imaging techniques, cause of the epistaxis can most often be elicited and by sticking to a management protocol recurrence can be reduced.
Epistaxis management - our point of view and literature review
Romanian Journal of Rhinology, 2017
Nasal haemorrhage or epistaxis is the most common otolaryngologic emergency. It affects about 60% of the population and a percentage of 6% do not cease spontaneously, medical approach being needed. The management of epistaxis varies depending on its severity and etiology. The therapeutic conduct of this ENT emergency is based on three main principles: 1. local haemostasis; 2. detection and ceasing of the cause; 3. evaluation and correction of hypovolemia if necessary. Haemostasis can be done by chemical or electric cauterisation after identifying the bleeding source, by nasal packing, by endoscopic or external surgery or, in special cases, when none of the above methods returns any results, embolization. The current paper emphasizes our experience and a brief literature concerning epistaxis management in patients presented in the Emergency Room, in chronic cases of vascular intranasal tumors with recurrent bleeding, in iatrogenic haemorrhages, and none of the least we will bring int...
Academic Emergency Medicine
After reading the article, participants should be able to discuss the effectiveness of an intervention to reduce peripheral IV insertion in the ED. Activity Disclosures No commercial support has been accepted related to the development or publication of this activity. No conflicts of interest or financial relationships relevant to this article were reported. This activity underwent peer review in line with standards of editorial integrity and publication ethics. Conflicts of interest have been identified and resolved in accordance with John Wiley and Sons, Inc.'s Policy on Activity Disclosure and Conflict of Interest. Accreditation John Wiley and Sons, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. John Wiley and Sons, Inc. designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. For information on applicability and acceptance of continuing medical education credit for this activity, please consult your professional licensing board. This activity is designed to be completed within 1 hour. To successfully earn credit, participants must complete the activity during the valid credit period, which is up to two years from initial publication. Additionally, up to 3 attempts and a score of 70% or better is needed to pass the post test.
The American Journal of Emergency Medicine, 2013
Objective: Epistaxis is a common problem in the emergency department (ED). Sixty percent of people experience it at least once in their life. There are different kinds of treatment for epistaxis. This study intended to evaluate the topical use of injectable form of tranexamic acid vs anterior nasal packing with pledgets coated with tetracycline ointment. Methods: Topical application of injectable form of tranexamic acid (500 mg in 5 mL) was compared with anterior nasal packing in 216 patients with anterior epistaxis presented to an ED in a randomized clinical trial. The time needed to arrest initial bleeding, hours needed to stay in hospital, and any rebleeding during 24 hours and 1 week later were recorded, and finally, the patient satisfaction was rated by a 0-10 scale. Results: Within 10 minutes of treatment, bleedings were arrested in 71% of the patients in the tranexamic acid group, compared with 31.2% in the anterior nasal packing group (odds ratio, 2.28; 95% confidence interval, 1.68-3.09; P b .001). In addition, 95.3% in the tranexamic acid group were discharged in 2 hours or less vs 6.4% in the anterior nasal packing group (P b .001). Rebleeding was reported in 4.7% and 11% of patients during first 24 hours in the tranexamic acid and the anterior nasal packing groups, respectively (P = .128). Satisfaction rate was higher in the tranexamic acid compared with the anterior nasal packing group (8.5 ± 1.7 vs 4.4 ± 1.8, P b .001). Conclusions: Topical application of injectable form of tranexamic acid was better than anterior nasal packing in the initial treatment of idiopathic anterior epistaxis.
European Annals of Otorhinolaryngology, Head and Neck Diseases, 2017
ANORL-602; No. of Pages 5 2 E. Bequignon et al. / European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2016) xxx-xxx is only feasible if the bleeding site is clearly visible. When the bleeding site is not identifiable or the first measures failed, anterior packing may be performed by a non-specialist physician. Epistaxis requires subsequent nasal endoscopy performed by an ENT specialist. Patients should be informed of the measures to be taken in case of epistaxis at home, and the risks associated with the various treatments.
Updates on the Management of Epistaxis
Clinical Medicine and Therapeutics, 2019
Epistaxis (i.e., nosebleed) is a common otolaryngologic emergency; however, it is seldom life-threatening and most minor nosebleeds stop on their own or under primary care from medical staff. Nonetheless, cases of recurrent epistaxis should be checked by an otolaryngologist, and severe nosebleeds should be referred to the emergency department to avoid adverse consequences, including hypovolemic shock or death. This paper reviews current advances in our understanding of epistaxis as well as updated treatment algorithms to assist clinicians in optimizing outcomes.