Epistaxis

Last reviewed: 18 Apr 2022
Last updated: 17 Sep 2020

Summary

Definition

History and exam

Key diagnostic factors

  • blood at one nostril or on both sides of nose
  • presence of risk factors
Full details

Other diagnostic factors

  • bleeding starting at the nares
  • recurrent epistaxis
  • septal deviation
  • bleeding starting in the throat
  • signs of haemodynamic compromise
  • intranasal polyp
  • telangiectasia
Full details

Risk factors

  • dry weather and low humidity
  • septal deviation
  • minor nasal trauma
  • nasal foreign body
  • nasal polyp
  • topical nasal drugs
  • primary coagulopathy (e.g., haemophilia)
  • medication (e.g., aspirin, anticoagulant, non-steroidal anti-inflammatory drugs)
  • familial hereditary haemorrhagic telangiectasia
  • juvenile nasal angiofibroma
Full details

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
Full details

Investigations to consider

  • FBC and ‘group and save
  • clotting studies (INR, prothrombin time, activated partial thromboplastin time, platelet function tests)
  • urea and electrolytes and serum creatinine
  • liver function tests (LFTs)
  • CT scan of paranasal sinuses
  • ECG
Full details

Treatment algorithm

INITIAL

active epistaxis: major haemorrhage

active epistaxis: no major haemorrhage

ACUTE

persistent epistaxis despite initial measures

ONGOING

epistaxis resolved

recurrent epistaxis

Contributors

Expert advisers

Alexander Alexiou, MB, BS, BSc, DCH, FRCEM, DipIMC RSEd

Flight Doctor

Greater Sydney Area Helicopter Emergency Medical Services

New South Wales

Australia

Disclosures

AA declares that he has no competing interests.

Acknowledgements,

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:

Darren Pinder, BSc(Hons), MB BChir, MSc(Med Ed), FRCS(ORL)

Consultant ENT Surgeon

Royal United Hospital Bath NHS Trust Bath

UK

Disclosures

DP declares that he has no competing interests.

Peer reviewers

Darren Pinder, BSc(Hons), MB BChir, MSc(Med Ed), FRCS(ORL)

Consultant ENT Surgeon

Royal United Hospital Bath NHS Trust

Bath

UK

Disclosures

DP declares that he has no competing interests.

Editors

Susan Mayor,

Lead Section Editor, BMJ Best Practice

Disclosures

SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.

Celia Pincus,

Section Editor, BMJ Best Practice

Disclosures

CP declares that she has no competing interests.

Jo Haynes,

Head of Editorial, BMJ Knowledge Centre

Disclosures

JH declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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