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.
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).
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.