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

 

• • See Hypertensive Crisis Protocol
  • Notify receiving facility or contact Medical Control

 

 

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