Lecture Notes: Nosebleeds (Epistaxis)

Overview

• Nosebleeds, also known as epistaxis, are a common medical condition.
• Bleeding typically originates from Kiesselbach's plexus in Little's area inside the nose.
• This area of the nasal mucosa is located at the front of the nasal cavity and is rich in blood vessels.
• Disruption of the mucosa exposes blood vessels, making them prone to bleeding.
• Little's area is a common exam topic; often tested as the most likely location of bleeding.

Common Triggers for Nosebleeds

• Nose picking
• Colds or viral upper respiratory tract infections
• Sinusitis
• Vigorous nose-blowing
• Trauma to the nose
• Changes in weather
• Coagulation disorders (e.g., thrombocytopenia, Von Willebrand disease)
• Use of anticoagulant medications (e.g., aspirin, DOACs, warfarin)
• Cocaine use
• Nasal tumors (e.g., squamous cell carcinoma)

Presentation

• Common in young children and older adults.
• Bleeding is usually unilateral (from one nostril).
• Bilateral bleeding may suggest posterior nasal bleeding, increasing the risk of blood aspiration into the lungs.
• Patients might report vomiting blood due to swallowing during a nosebleed.

Management of Nosebleeds

• Many nosebleeds resolve without medical intervention.
• First-line at-home management:
  • Sit up and tilt head forward to let blood run forward.
  • Pinch the soft part of the nostrils for 10-15 minutes.
  • Spit out any blood in the mouth instead of swallowing.
• When to seek medical attention:
  • Bleeding does not stop after 10-15 minutes.
  • Severe bleeding or bleeding from both nostrils.
  • Patient is hemodynamically unstable.

Medical Treatment Options

• Nasal packing: Use nasal tampons or inflatable packs.
• Nasal cautery: Use silver nitrate sticks.
• After acute bleeding stops, naseptin nasal cream may be prescribed:
  • Contains chlorhexidine and neomycin (antibiotic).
  • Apply four times daily for 10 days to reduce crusting, inflammation, and infection.
  • Contraindicated in patients with peanut or soya allergies.

Additional Resources

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