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Clinical Guide - Epistaxis

There follows some brief advice on the management of epistaxis. It should be read in conjunction with the tutorial of the same name. 


What is epistaxis?


It is a nosebleed. This is common in children and in older adults and is caused by disease in the nose (trauma, infection, tumour) or by systemic illnesses such as haemophilia. Other causes include non-steroidal pain relief (aspirin, ibuprofen) usage and Warfarin. Quite often the bleed starts for no real reason.


How do they present?


Broadly speaking they will present in one of two ways:

1.  As a severe active bleed requiring immediate medical care

2. As a recurring issue that troubles the patient intermittently


Active bleeds.


Sit the patient down, pinch the soft part of the nose, lean the patient forwards and have them breathe calmly through their mouth. They should not swallow the blood as this will make them feel sick and they may vomit.


After 15 minutes the patient may let go of their nose. If the bleeding continues, send them to the hospital. If it has stopped they should have bed rest for a day.

Intermittent bleeds.


Silver nitrate cautery of the nose is the usual treatment for bleeds in Little's area but this is not available in Cambodia at present. As an alternative, you should use creams in the nose for ten days. This is effective at removing infection in the nose and combating dryness in the anterior nose.


Cream: Mupirocin cream is currently available and will make a reasonable treatment. Make sure the patient is not allergic to it.


Oral medications are not effective.


Caution: Active nosebleeds can kill. Offer immediate first aid as above and get the patient to a hospital.

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