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Epistaxis - Management
How should I assess a person with recurrent epistaxis?
- Ask the person about:
- Which side the bleeding occurs.
- How much blood is lost during an episode. This is difficult to estimate, but establish whether the bleeding is light or heavy. If bleeding is heavy, ask the person how many cups (each equates to approximately 250 mL) they think they have lost.
- How previous episodes of epistaxis have been treated. Mild episodes usually stop with first aid measures. The need for cautery or packing indicates a more severe bleed.
- Examine both nasal passages (ideally with adequate lighting and a nasal speculum).
- Look for a bleeding point. Bleeding points which have stopped look like a small red dot (less than 1 mm).
- Check for a nasal tumour.
- Determine if there is an underlying cause, particularly in children younger than 2 years of age as epistaxis is unusual in this group.
- Laboratory investigations are not usually required unless an underlying cause is suspected.
- A full blood count should be considered if bleeding has been heavy or recurrent, or anaemia is suspected.
- Coagulation studies should be requested only if a clotting diathesis is suspected or an INR (international normalized ratio) is required to determine if warfarin treatment needs adjusting.
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