The following questions relate to patients with epistaxis. For each of the scenarios please select the correct management from the options below. Each answer may be used once, more than once or not at all.
i) Simple first aid alone
ii) Naseptin cream
iii) Silver nitrate nasal cautery
iv) Anterior nasal packing
v) Posterior nasal packing
vi) Examination of the nose under general anaesthetic
vii) Ligation of the external carotid artery
viii) Embolisation of the affected vessel
a) While out walking in the countryside you come across a 10-year-old boy who has been hit in the face with a branch when climbing a tree. He has a small ooze from both nostrils and is attempting to stem the flow of blood by dabbing the nose with the sleeve of his T-shirt.
b) A 19-year-old girl suffers a nasal injury playing rugby. She was admitted to A&E and required bilateral anterior nasal packs to achieve haemostasis. You are called to the ward to see the patient as she is now continuing to spit out fresh blood and has also had some blood coming from her eyes.
c) A 56-year-old lady on warfarin for atrial fibrillation continues to bleed despite both anterior and posterior nasal packing being inserted. The INR is 2.0, all other blood results are normal.
d) A 35-year-old man has been suffering from recurrent epistaxis from the right nostril lasting 10 -15 minutes that stops with simple first aid. On examination, he has a prominent blood vessels in Little's area on the right side, he is not actively bleeding and is haemodynamically stable.
e) A 65-year-old man has been admitted to ENT ward for the last 2 weeks for a severe left-sided epistaxis. Since admission, he has had two attempts at anterior nasal packing but has bled after each attempt at removing the packs. After the last attempt he was taken to theatre and underwent an SPA ligation. Despite this, he has again started bleeding heavily from the left side.