Epistaxis

Epistaxis is a common ENT emergency. Most patients can be treated as an outpatient, either at the emergency or at the office.

Patients on anticoagulant present a very high risk of epistaxis. However, it is important not to stop the medication without the advice of the treating physician.

To stop nasal bleeding, an acceptable approach is local compression of the nose. The patient is asked to sit down, to lean forward to avoid swallowing the blood and to reduce the risk of nausea and vomiting, and pinching his nostrils (anterior part of the nose) for at least ten minutes.

If bleeding continues, different therapeutic levels can be made:

The ENT looks for the bleeding site and can cauterize it with silver nitrate or electrocautery. We must take care not to cauterize both sides of the nasal septum in the same session to prevent a subsequent perforation.

If you cannot view the location of the bleeding, and we cannot cauterize the place or cauterization does not work, anterior nasal packing with Vaseline or other type of available packing needs to be done.

 

 

Counseling for patients nose bleeding:

1. Do not hardly blow your nose.
2. Use a lubricant gel or nasal spray.
3. Do not remove the crusts that can be developed in the nose.
4. Do not make physical effort for the next two weeks.
5. Do not take aspirin or anti-inflammatory drugs.
6. Coughing or sneezing with the mouth open to decrease the risk of nasal bleeding.
7. Ideally, maintain humidity levels in the house around 35% to 40%. This will prevent the formation of nasal crusts.
8. If a nosebleed occurs, pinch the soft part of the nose between thumb and forefinger for ten minutes.

Reference: Le Médecin du Québec, Volume 42, Number 5, May 2007

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Emergency in ENT
Peritonsillar abscess
Ludwig’s Angina
Foreign body in the ear
Foreign body in the respiratory tract (nose, trachea, bronchi)
Foreign body in the esophagus
Epiglottitis
Epistaxis
Perilymphatic fistula
Nose fracture
Hemorrhage post-adenotonsillectomy
Acute mastoiditis
Facial paralysis
Sudden hearing loss