NOSE BLEED (EPISTAXIS)

Epistaxis often occurs from the plexus of veins in the anterior part of the nasal septum (Figure 5.16). In children it is often due to nose picking; other causes include trauma, a foreign body, Burkitt’s lymphoma and naso-pharyngeal carcinoma.

Figure 5.16

Manage epistaxis with the patient in a sitting position. Remove blood clots from the nose and throat to visualize the site of bleeding and confirm the diagnosis. Pinch the nose between your fingers and thumb while applying icepacks to the nose and forehead. Continue to apply pressure. Bleeding will usually stop within 10 minutes. If bleeding continues, pack the anterior nares with petroleum impregnated ribbon gauze.

If bleeding continues after packing, the posterior nasopharynx may be the source of bleeding. Apply pressure using the balloon of a Foley catheter. Lubricate the catheter, and pass it through the nose until the tip reaches the oropharynx. Withdraw it a short distance to bring the balloon into the nasopharynx. Inflate the balloon with water, enough to exert pressure but not to cause discomfort (5–10 ml of water is usually adequate for an adult, but use no more than 5 ml for a child). Gently pull the catheter forward until the balloon is held in the posterior choana (Figure 5.17).

Figure 5.17

Tape the catheter to the forehead or cheek in the same manner as a nasogastric tube. With the catheter in place, pack the anterior nares with petroleum gauze. Deflate the Foley catheter after 48 hours and, if bleeding does not recur, remove it.