Epistaxis

 

History:

 

  • Age
  • Past medical history
  • Medications (HTN, anticoagulants, Aspirin, non-steroidal anti- inflammatory drugs)
  • Previous episodes of epistaxis
  • Trauma
  • Duration of bleeding
  • Quantity of bleeding

 

Significant Findings:

 

  • Bleeding from nasal passage
  • Pain
  • Nausea
  • Vomiting

 

Differential:

 

  • Trauma
  • Allergic rhinitis
  • Hypertension
  • Lesions
  • Polyps
  • Ulcers
  • Infection
  • Viral upper respiratory infection
  • Sinusitis

 

Treatment:

 

 

 

  • Compress nostrils
  • Cold packs to bridge of nose
  • Apply nasal clip
  • Tilt head forward
  • Orthostatic blood pressure if needed

 

 

 

  • Initiate IV

 

Hypotensive ?

 

  • Yes

 

 

 

    • Consider Normal Saline 20 mL/kg IV; max 60 mL/kg or 1,000 mL for pediatric or up to 1,000 mL IV for adult

 

Hypertensive ?

 

  • Yes

 

 

 

PEARLS:

 

  • Pediatric = 1 day to less than age 12, or less than 55 kg in ages 13-18.
  • Use Broselow tape for pediatric drug dosages.
  • It is very difficult to quantify the amount of blood loss with epistaxis.
  • Bleeding may also be occurring posteriorly. Evaluate for posterior blood loss by examining the posterior pharynx.
  • Anticoagulants include Aspirin, Coumadin, non-steroidal anti-inflammatory medications (Ibuprofen), and many over the counter headache relief powders

NREMR

National Registry Emergency Medical Responder

NREMT-I

National Registry EMT-Intermediate

NREMT-I

National Registry EMT-Intermediate