Epistaxis
Formal Definition
Bleeding from the nasal cavity; classified as anterior (90% of cases, originating from Kiesselbach plexus on the anterior nasal septum, typically minor and self-limited) or posterior (rare, more severe, originating from sphenopalatine artery, requiring specialist intervention).
How It's Used on the Ward
"Nosebleed" — at the patient level. "Epistaxis" in documentation and clinical discussion.
Example
""Patient pinching nose for 20 minutes with continued bleeding: anterior rhinoscopy shows oozing from left Little area. Silver nitrate cautery after adequate anesthesia with oxymetazoline-soaked cotton; if that fails, anterior packing with Merocel or Rhino Rocket.""
Clinical Context
First-line management: direct pressure (pinch soft part of nose, lean forward, 10–15 min continuous pressure). Topical vasoconstrictors (oxymetazoline, cocaine spray) help. Cauterize visible vessel with silver nitrate if actively oozing. If refractory: anterior nasal packing (Merocel or Rapid Rhino). Posterior epistaxis: posterior nasal packing or balloon tamponade (Foley catheter method) — requires ENT and admission for monitoring (hypoxia risk). Anticoagulated patients: reverse if actively hemorrhaging. Hematologic causes: check CBC, coagulation if recurrent or severe. Hereditary hemorrhagic telangiectasia (HHT/Osler-Weber-Rendu): recurrent epistaxis + AVMs — refer to genetics.
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