EPISTAXIS

Nose Bleeding

Bleeding from the nostrils, which may be arterial or venous

Causes

  • Local: nose-picking, trauma, nose infections, tumours
  • General: hypertension, bleeding disorders, pertussis, Sickle-cell trait/disease, renal failure, often familial
  • Can also be a symptom of serious disease, e.g., typhoid, malaria, viral fevers such as Ebola

Clinical features

  • On examination, site of bleeding from nose may be seen
  • Signs and symptoms of shock if bleeding is severe
  • Signs and symptoms of predisposing cause

Differential diagnosis

  • Clinical assessment to exclude any of above causes

Investigations

  • Blood: Full blood count, platelet count

MANAGEMENT

First aid

  • Sit the patient up (if patient not in shock) and tilt head forward not backwards to avoid pooling of
    blood in posterior pharynx
  • Instruct patient to pinch the nose between the finger and the thumb for 15 minutes, breathe
    through the mouth, and spit out any blood

If bleeding continues

  • Impregnate a gauze strip with Soft paraffin or Tetracycline eye ointment and pack into the nose
    using forceps
  • Leave gauze in place for 24-48 hours

If bleeding still does not stop after this period

  • Refer to hospital for further management

Prevention

  • Avoid picking the nose
  • Treat/control predisposing conditions