Updates on the Management of Epistaxis (original) (raw)
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Clinical Practice Guideline: Nosebleed (Epistaxis) Executive Summary
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 great 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. Inpatie...
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...
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...
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.
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.
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.
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...
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.
Evaluation of Local Causes of Epistaxis and Its Management Outcome in a Tertiary Care Hospital
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Epistaxis is a very common problem. It may be a symptom of minor or serious ailments with underlying local or systemic causes. The objectives of this study are to evaluate various local causes of epistaxis and its management outcome. MATERIALS AND METHODS A descriptive study was conducted among 120 patients who presented with epistaxis of local causes. Individual sampling unit was selected using convenience sampling technique. Nasal pinching, anterior nasal packing and posterior nasal packing were performed in conservative management. Electrocauterisation, septal surgery, nasopharyngeal surgery and endoscopic arterial ligation were considered in surgical intervention. Descriptive statistics like proportion, mean and standard deviation were calculated. For inferential statistics, Chi-square test was performed wherever applicable. RESULTS Males were more compared to females with a male and female ratio of 1.2: 1. The number of patients were more in winter and autumn; and low during monsoon season. On rhinoscopic examination 53.33% cases had bleeding from the septum, out of which 81.25% was from anterior part and 18.75% was from posterior part of the septum. Most of the nasal trauma was due to road traffic accident. Hippocratic method was performed with a success rate of 80% to control bleeding. CONCLUSION Traumatic epistaxis was the most common local cause of epistaxis. Cold, dry and low humidity may lead to higher incidence of epistaxis in the winter season. The incidence of epistaxis was higher in young adults and middle-aged people. The anterior nasal packing had more convenient and higher control among all the conservative measures.