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By ULY CLINIC

 

Nose Bleeding (Epistaxis)

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Introduction

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Nose bleeding is a condition which is common in adults. It may be due to a local cause in the nasal cavity (e.g. trauma, tumor, foreign body, septal varisces, or septal deviation); or a systemic cause (e.g. blood disorders, vascular disorders, renal failure, hepatic failure, or use of anticoagulants (warfarin, heparin). Most cases of epistaxis are minor; do not require hospitalization. Patients with significant nose bleeding do require hospitalization. 

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Non-Pharmacological Treatment 

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  • Stabilize the patient: put an open intravenous line, do blood grouping and cross matching

  • Put the patient in a sitting position and advise the patient to pinch the soft part of the nose gently for 5 minutes

  • Put on a gown, glasses, head light and sterile gloves and evacuate clots.Do a thorough head and neck examination

  • Cauterize septal varisces (if any) using a silverex stick  

  • Do an anterior nasal packing by introducing into the nasal cavity as far posterior as possible sterile Vaseline gauzes (or iodine soaked gauzes if not available) using a dissecting forcep (if bayonet forcep is not available)

  • Put rolled dry gauze on the collumela and plaster it  If the patient is still bleeding

  • Do a posterior nasal packing using a Foley’s catheter introduced through the nasal cavity into the oropharynx, balloon it with normal saline up to 10–15cc while pulling it outward to impinge on the posterior nasal choana, then do anterior nasal packing as above

  • Put dry gauze on the nose to prevent necrosis of the collumela and fix the catheter on the nose with an umbilical clamp

  • Almost all of the nasal bleedings will be controlled by this way 

 

Note: Remove the packs after 72 hours 

 

Pharmacological Treatment (to prevent rhinosinusitis)

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  • Phenoxymethylpenicillin (PO) 500mg every 8 hours for 7 days. Children up to 5 years: 6 mg/kg 6 hourly for 10 days    

OR

  • Azithromycin (PO) 500mg once daily for 3 days. Children: 10mg/kg once daily for 3 days     

OR

  • Amoxicillin/Clavulanic acid (PO) Adults: 625mg (500mg amoxicillin+125mg Clavulanic acid) 8 hourly for 7 days  Children: 375mg (250mg amoxicillin+125 Clavulanic acid) 12 hourly for 7 days;     

PLUS

  • Paracetamol (PO) 1gm 8hourly until fever is controlled  Children 10 mg/kg body weight 8 hourly until fever is controlled  

 

NOTE: Putting an ice cube on the forehead, extending the neck or placing a cotton bud soaked with adrenaline in the vestibule will not help 

 

 

Referral:

 

Refer the patient to the next facility with adequate expertise and facilities if: 

  • he patient is still bleeding repack and refer immediately

  • Failure to manage the underlying cause, refer the patient 

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Updated on, 30.10.2020

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References

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1. STG 

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