{"id":3912,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/epistaxis\/"},"modified":"2024-05-22T16:27:02","modified_gmt":"2024-05-22T15:27:02","slug":"epistaxis","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/entadult\/nose\/epistaxis\/","title":{"rendered":"Epistaxis"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">Assessment<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Duration, predisposing factors, history of injury<\/li>\n\n\n\n<li>Determine whether bleeding is unilateral or bilateral<\/li>\n\n\n\n<li>Determine whether bleeding is anterior or posterior<\/li>\n\n\n\n<li><strong>Medications<\/strong> \u2013 NSAIDS, aspirin, Warfarin or DOACs<\/li>\n\n\n\n<li><strong>Past medical history<\/strong> \u2013 coagulopathy, platelet disorder or hypertension. If suspecting blood dyscrasia<\/li>\n\n\n\n<li>Thorough history (including bruising, bleeding)<\/li>\n\n\n\n<li>Family history<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Examination<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>BP, pulse if active bleeding<\/li>\n\n\n\n<li>Anterior rhinoscopy \u2013 ?bleeding point, visible vessels in Little\u2019s area, crusting, septal perforation, mass present.<\/li>\n\n\n\n<li>Posterior epistaxis indicated by failure to visualise an anterior source, haemorrhage from both sides or oro-pharyngeal blood.&nbsp;&nbsp;<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Investigation<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If significant blood loss, recurrent episodes check FBC<\/li>\n\n\n\n<li>If on anticoagulants or suspect coagulopathy check clotting, renal and liver function <\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Secondary Care Referral<\/h4>\n\n\n\n<p><strong>Adults<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If recurrent epistaxis not improved with primary care management refer to adult service (SJH\/LB) for routine review. Consider withholding any anticoagulants.<\/li>\n\n\n\n<li>If recurrent epistaxis resulting in significant drop in Hb or has history of haematological problem (low platelets\/abnormal clotting) refer as urgent for review in OP<\/li>\n\n\n\n<li>If epistaxis is unilateral and associated with lesion visualised in anterior nose or significant pain\/obstruction refer as urgent for review in OP (SJH\/LB)<\/li>\n\n\n\n<li>If episode of epistaxis not controlled with first aid measures and still bleeding after 20 minutes compression, especially if cardiovascularly unstable transfer to A+E (RIE\/SJH), who will refer to ENT if necessary.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">First Aid Advice<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Pinch soft anterior part of nose for 20 minutes<\/li>\n\n\n\n<li>Lean forward<\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Primary care options<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Naseptin ointment (adults) twice daily&nbsp;for 2 weeks (NOT SUITABLE FOR PEANUT ALLERGY in which case Mupirocin is an option)<\/li>\n\n\n\n<li>Cautery using silver nitrate sticks if able to provide in community (avoid cautery bilaterally at same time, stage cautery one side and then the other 4-6 weeks later)<\/li>\n\n\n\n<li>If Epistaxis recurs on stopping Naseptin, try Vaseline prn<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/ears-nose-and-throat\/nosebleed\">Nosebleed | NHS inform<\/a><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Assessment Examination Investigation<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4183,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[151],"class_list":["post-3912","page","type-page","status-publish","hentry","category-epistaxis"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/entadult\/nose\/epistaxis\/\" rel=\"tag\">Epistaxis<\/a>","rttpg_excerpt":"Assessment Examination Investigation","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3912","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3912"}],"version-history":[{"count":6,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3912\/revisions"}],"predecessor-version":[{"id":19545,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3912\/revisions\/19545"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4183"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3912"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3912"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}