Epistaxis
Nosebleed from the anterior Kiesselbach plexus or the posterior sphenopalatine artery territory, managed with a stepwise escalation from first aid through cautery, packing, and, for refractory bleeding, embolization or surgical ligation.
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What this article covers
- Overview
Epistaxis is bleeding from the nasal mucosa, classified by source as anterior (from the Kiesselbach plexus on the septum) or posterior (from sphenopalatine artery branches), a distinction that drives the entire management sequence.
- Epidemiology
Epistaxis is a common problem, affecting up to 60% of the U.S.
- Risk factors
Anticoagulant or antiplatelet therapy, including for atrial fibrillation, stroke prevention, or peripheral arterial disease, increases both the frequency and severity of bleeding.
- Pathophysiology
Anterior bleeding arises from the Kiesselbach plexus (Little's area), an anastomotic network on the anterior septum formed by the septal branch of the anterior ethmoidal artery, the lateral nasal…
- Clinical features
Active bleeding from one or both nares, seen or reported by the patient, is the defining finding; unilateral bleeding with a visible anterior source on rhinoscopy is typical of anterior epistaxis.
- Differential diagnosis
Hemoptysis: blood originates from the lower respiratory tract (cough-associated, frothy, mixed with sputum); anterior rhinoscopy and history of a preceding cough versus a nasal source distinguish it…
- Diagnosis
Epistaxis is a clinical diagnosis made by direct visualization of bleeding from the nasal cavity; the essential first step is not a test but localization of the source with anterior rhinoscopy (nasal…
- Management
First, position the patient sitting up and leaning forward to avoid swallowing blood, and apply a cold compress to the nasal dorsum.
- Complications
Hemodynamically significant blood loss, more common with posterior bleeding, which can require transfusion and hospitalization.
- Prognosis
Anterior epistaxis is generally self-limited and responds to first aid, cautery, or anterior packing in the great majority of cases, with low morbidity.
- Prevention
Remove nasal packing within 72 hours to reduce the risk of toxic shock syndrome, sinus infection, and septal necrosis.
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