Epistaxis

The bleeding usually comes from Kiesselbach’s plexus, which is in Little’s area in the front of the nasal cavity.

It can be triggered by nose-picking, vigorous nose-blowing, trauma, anticoagulants, coagulopathy, tumours, or snorting drugs.

If the blood is swallowed, the patient can present with Haematemesis, but this is more commmon in bilateral bleeds as it indicates posterior bleeding.

Management

1st line - Direct compression - Patient should sit up, tilt head down, squeeze cartilaginous part of nose, and open mouth for 10-15 mins.

• Leaning forward decreases blood flow through the nasopharynx, allows spitting out of blood, and minimises swallowing the blood that drains into the pharynx

If bleeding continues after 10-15 minutes, nasal cautery should be tried, followed by nasal packing.

If recurrent and significant bleeds, refer for further investigations to look for an underlying cause.