Epistaxis: The Balloon and the Nose

First Aid (before arriving on scene)

Advise patient (or carer regarding the patient) to:

1. Sit down
2. Lean slightly forward
3. Breath through mouth
4. Pinch the nose so that the nostrils are closed between thumb and forefinger (with firm, consistent pressure) for 10 minutes
5. Suck on ice (alternatively, apply cold compress to bridge of nose)

First, ABCs:

1. Patent airway?
2. Any CVS Instability ⇒ insert large bore intravenous cannula ⇒ IVF
3. Personal Protective Equipment
4. Nasal speculum examination (to identify source)

While doing this, ask:

• On which side did the bleeding start?
• When did the bleeding start?
• How much blood has been lost?
• Has this happened before? (Is this a chronic or recurrent problem?)

Most nose bleeds are from the anterior vestibule and involve a complex of vessels (Kiesselbach’s plexus) in the region of the nose known as Little’s Area. Most can be controlled by local pressure.

Nasal speculum examination

1. nasal speculum +/- suction
2. pledget moistened in oxymetazoline (vasoconstrictor) and anaesthetic (2% xylocaine) OR Co-Phenylcaine Forte
3. Remove after several minutes and reassess
   1. lie back at 30 degrees
   2. good lighting
   3. examine anterior mucosa (speculum) especially Kiesselbach plexus
   4. +/- blow nose gently to remove clots / suction catheter
   5. cauterise
   6. petroleum jelly / antiseptic cream
      1. cephalexin 250 mg tid po
      2. augmentin 250 mg tid po
      3. clindamycin 150 mg qid po
   7. pack
   8. no hot beverages / spicy food / alcohol for 48 hours
   9. avoid vigorous nose blowing or sneezing through the nose (keep mouth open) for 1 week
   10. no vigorous activity 1 week
   11. Mama don’t allow no nose picking around here…..

Prevention

1. Petroleum Jelly per nostril
2. Antiseptic cream (recurrent epistaxis)
3. Humidifier

Recall:

• Children < 10 (90% anterior)
• Adults > 50
• Younger children < 2 (rare)

Consider:

• accidental v. non-accidental trauma
• nasal foreign body
• systemic condition (bleeding disorder)

Epistaxis Tray

• nasal decongestant
• local anaesthetic (xylocaine 2%)
• silver nitrate sticks (or electric cautery)
• bayonet forceps
• nasal speculum
• Frazier suction (with appropriate tip)
• Packing materials
  • pledgets
  • Pope epistaxis packing / Rapid Rhino

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CoPhenylcaine Forte Spray