Clinical Practice Guideline: Nosebleed (Epistaxis) Executive Summary (original) (raw)
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Clinical Practice Guideline: Nosebleed (Epistaxis)
Otolaryngology–Head and Neck Surgery
Objective Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the United States. While the majority of nosebleeds are limited in severity and duration, about 6% of people who experience nosebleeds will seek medical attention. For the purposes of this guideline, we define the target patient with a nosebleed as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient’s quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hos...
A double-blind randomized controlled trial of management of recurrent nosebleeds in children
Otolaryngology–Head and Neck Surgery, 2009
Background: To establish whether a treatment regimen of silver nitrate cautery and 4 weeks of antiseptic nasal cream is superior to antiseptic cream treatment alone in the management of pediatric epistaxis. Study Design: Double-blind randomized controlled trial. Subjects and Methods: Children with epistaxis and visible anterior septal vessels were invited to participate. Patients were randomized to receive treatment or control. Treatment patients received silver nitrate cautery, followed by antiseptic cream for 4 weeks. Control patients received sham cautery followed by antiseptic cream for 4 weeks. Results: A total of 109 patients were randomized and results were available for 93 (85%). Of those receiving cautery, 21 (45.7%) of 46 had no bleeding in the 4 weeks before follow-up. Of those receiving only antiseptic cream 14 (29.8%) of 47 had no bleeding. (χ2 = 2.49; P = 0.114). More children in the active treatment group had an improvement in their symptoms compared with controls (42...
Nasal Packs for Epistaxis: Predictors of Success
Clinical Otolaryngology, 2020
ObjectivesTo investigate factors affecting the haemostatic success of non‐dissolvable intranasal packs in the management of acute epistaxis presenting to the emergency department (ED).DesignProspective cohort study.SettingA nationwide prospective audit examining epistaxis management at 113 sites in the UK over a 30‐day period.ParticipantsPatients 16 years or older, presenting to the ED with acute epistaxis managed with non‐dissolvable intranasal packs.Main outcome measuresThe primary outcome was pack success, defined as successful haemostasis following nasal pack removal, not requiring further packing or surgical intervention or interventional radiology.ResultsA cohort of 969 patients presented with epistaxis to the ED, with nasal packs being inserted in 54.4% by ED staff and by ENT in a further 18.9%. Overall, nasal packs were successful in 87.5%. Longer duration packs (≥21 hours) were more successful than shorter‐duration packs (89.9% vs. 84.3%, χ2 P = .028). A patient survey supp...
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.
Nasal endoscopy and localization of the bleeding source in epistaxis: last decade's revolution
Brazilian Journal of Otorhinolaryngology, 2005
Epistaxis remains one of the most common otolaryngology emergencies. Despite considerable interest in the subject, there is still no consensus on the most appropriate primary therapeutic modality. Aim: The purpose of this study was to evaluate the bleeding source of acute or recurrent epistaxis in adults. Study Design: Clinical prospective. Material and Method: Thirty adults patients with acute or recurrent epistaxis were evaluated through the use of frontal light and endoscope for identification of the bleeding source in the nasal cavity. Results: Use of the nasal endoscope allowed diagnosis of the bleeding site in all patients. Conclusion: A careful examination of the posterior nasal cavity allows identification of the bleeding source in most patients and should be a routine procedure.
ISRN otolaryngology, 2011
Paediatric epistaxis is common and usually of benign origin. However, the differential diagnosis includes serious underlying pathology (e.g., bleeding disorders and blood cancers) and in the very young can be a marker of potential physical abuse. To assess if paediatric and A&E doctors were aware of the important differential, we asked them to complete a Likert scale questionnaire on several different clinical scenarios. Our results show that a significant proportion of doctors of all grades and in both specialties were either not aware of or not concerned about epistaxis in an infant as a possible sign of nonaccidental injury and were not willing to carry out simple blood tests to investigate recurrent nosebleeds in an older child. Our results highlight the need for education and evidence-based guidelines to avoid missing important, if infrequent, causes of paediatric epistaxis, both in the hospital and community setting.
Ear, nose, & throat journal, 2011
We believe that the use of cauterization in patients with anterior epistaxis in the absence of acute bleeding should be discouraged because it does not address the underlying cause and because it may even worsen the condition by extending the degree of mucosal disruption. This is especially true in patients who are receiving anticoagulation therapy. Therefore, we conducted a study to determine if the use of a nasal saline gel as monotherapy would be an effective alternative to invasive measures in treating recurrent epistaxis in anticoagulated patients. Our study group consisted of 74 patients-43 men and 31 women (mean age: 64.4 yr)-who had been seen in our department over an 18-month period and whose bleeding had originated in the anterior portion of the nasal vault. Most patients had been experiencing epistaxis for at least 6 months. Patients were given the saline nasal gel and taught to gently apply it to the mucosa of the anterior nasal vault with a cotton-tipped applicator at t...
The management of epistaxis in accident and emergency departments: a survey of current practice
Emergency Medicine Journal, 1990
A short questionnaire on the subject of the management of epistaxis was sent to forty accident & emergency departmzents in two NHS regions. Thirty replies were received (response of 75%). It was found that all departnents were involved in the initial management of epistaxis, but the extent of that involvement varied considerably. One of the most obvious factors contributing towards the degree of involvement was the liaison between the accident & emergency and the ENT departments. Three departments never referred patients to the ENT departmxent for follow-up. Nine departments performed their own nasal cautery, but half of these did not use any form of local anaesthesia. Twenty-seven departmxents used various forms of nasal packing but, of these, two-thirds did not use any form of local anaesthesia. Twenty-three departments allowed patients to go home with a nasal pack in situ. The results of this survey are discussed and a guideline to the management of epistaxis in an accident & emergency setting is suggested.
Surgical treatment of nasal packing refractory epistaxis
Brazilian Journal of Otorhinolaryngology (Impresso), 2009
Epi staxis is the main otorhinolaryngology emergency and, in severe cases, it can lead to hemodynamic instability and be life threatening. Aim: To evaluate factors involved in epistaxis resistant to nasal packing that needed surgical treatment, as well as post-surgical results. Material and Methods: Retrospective study from January 2002 to August 2007. 40 consecutive patients that underwent surgical treatment for refractory epistaxis were analyzed. Predisposing factors, procedures performed, need of blood transfusion, and recurrence were evaluated. Results: Otorhinolaryngology post operative complications (37.5%), high blood pressure (30%), and coagulopathy (15%) were the main factors related to epistaxis. 50% of the patients (n=20) presented with hemodynamic instability and 90% of them (n=18) needed blood transfusion. Eletrocauterization of the bleeding site was enough in 35% of these patients (n=14), while in 65% (n=26) was necessary cauterization and/or arterial ligation. Five patients (12.5%) had bleeding recurrence, which needed re-operation. Conclusion: Earlier indications of surgical treatment to control severe and refractory epistaxis to conventional treatment, especially in a population with high risk such as post operative bleeding and coagulopathies, may decrease the need of blood transfusion.