Epistaxis is one of the most common ear, nose, and throat emergencies, with an estimated 60% lifetime incidence rate for an individual person. Of this group, approximately 6% seek medical care to stop the bleeding. Epistaxis has a bimodal age distribution, with most cases in children 2-10 years old and adults 50-80 years old. Certain high-risk groups, such as the elderly, require rapid intervention to stem bleeding and prevent further complications.1
Explore This IssueACEP News: Vol 28 – No 06 – June 2009
The treatment of epistaxis has undergone significant changes in recent years. Gone are the days when an uncomfortable nasal pack is inserted, with rebleeding upon removal several days later fairly common. New packing devices and ingenious hemostatic agents have been developed to provide a variety of effective and well-tolerated treatment options.2
Treatment of any patient with epistaxis starts with ensuring a secure airway and hemodynamic stability. Ninety percent of nosebleeds are anterior and can be controlled by pinching the anterior aspect of the nose. While awaiting physician evaluation, the triage nurse can place a clamping device constructed of four tongue blades secured together by 1-inch tape over Kiesselbach’s plexus, the anterior portion of the nasal septum where there is an anastomotic network of vessels. Evaluation and treatment of epistaxis is expedited by having all of the supplies available in the patient’s room (see “Epistaxis Box Supplies”). Good lighting, such as a headlight, is essential and keeps both hands free.
The first step in identifying the source of bleeding is to clear the nose of blood either by the patient blowing the nose or by suctioning. Topical oxymetazoline (Afrin) spray alone often stops the hemorrhage. LET solution (lidocaine 4%, epinephrine 0.1%, and tetracaine 0.4%) applied to a cotton ball or gauze and allowed to remain in the nares for 10-15 minutes is very useful in providing vasoconstriction and analgesia. Lidocaine 4% spray may be substituted. Some clinicians use topical cocaine hydrochloride, which is available in 4% and 10% solutions and has both topical anesthetic and vasoconstrictive effects as a single agent.