Excerpt from Epistaxis

Synonyms, Key Words, and Related Terms: nasal hemorrhage, nosebleed, nose bleed, bloody nose, nasal packing

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Background

Epistaxis is defined as acute hemorrhage from the nostril, nasal cavity, or nasopharynx. It is a frequent ED complaint and often causes significant anxiety in patients and clinicians. However, more than 90% of patients who present to the ED with epistaxis may be successfully treated by an emergency physician (EP).

Pathophysiology

Epistaxis is classified on the basis of the primary bleeding site as anterior or posterior. Hemorrhage is most commonly anterior, originating from the nasal septum. A common source of anterior epistaxis is the Kiesselbach plexus, an anastomotic network of vessels on the anterior portion of the nasal septum. Anterior bleeding may also originate anterior to the inferior turbinate. Posterior hemorrhage originates from branches of the sphenopalatine artery in the posterior nasal cavity or nasopharynx.

Frequency

United States

Epistaxis occurs in 1 of every 7 people.

Mortality/Morbidity

Mortality is rare and is usually due to complications from hypovolemia, with severe hemorrhage or underlying disease states.
Increased morbidity is associated with nasal packing. Posterior packing can potentially cause airway compromise and respiratory depression. Packing in any location may lead to infection.

Sex

No sex predilection exists.

Age

Bimodal incidence exists, with peaks in those aged 2-10 years and 50-80 years.

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