Summary
Definição
História e exame físico
Principais fatores diagnósticos
- blood at both sides of nose
Outros fatores diagnósticos
- bleeding starting at the nares
- recurrent epistaxis
- septal deviation
- tachycardia
- bleeding starting in the throat
- hypotension
- syncope
- dizziness or lightheadedness
- pallor
- hypoesthesia and pain in the distribution of the second branch of the trigeminal nerve
Fatores de risco
- dry weather and low humidity
- prior nasal or sinus surgery
- nasal cannula oxygen or continuous positive airways pressure (CPAP)
- nasal and other facial fracture
- other nasal trauma
- use of intranasal drug formulations or illicit drugs
- primary coagulopathy (e.g., hemophilia)
- use of certain systemic drugs
- familial hereditary hemorrhagic telangiectasia
- juvenile nasal angiofibroma
- chronic kidney or liver disease
- septal deviation
- nasal foreign body
- environmental irritants
- barotrauma
- ulceration secondary to infection (e.g., herpes zoster, or bacterial infection)
- forceful coughing
- sinonasal neoplasm
- chronic granulomatous disease
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- clinical diagnosis
Investigações a serem consideradas
- CBC
- coagulation studies (prothrombin time, activated partial thromboplastin time, platelet function tests)
- BUN, serum creatinine
- LFTs
- nasal endoscopy and nasopharyngoscopy
- autoimmune screen/autoantibodies
- CT scan of paranasal sinuses
- MRI of head
- internal and external carotid angiography
- plain nasal or sinus x-ray
Algoritmo de tratamento
active epistaxis: initial measures
active epistaxis: persistent bleeding precluding identification of bleeding site
active epistaxis: bleeding site visible
quiescent but recurrent epistaxis
Colaboradores
Consultores especialistas
Madeleine R. Schaberg, MD, MPH, FACS
Director of Endoscopic Sinus, Rhinology, and Skullbase Surgery
The New York Eye and Ear Infirmary of Mount Sinai
Department of Otolaryngology, Head and Neck Surgery
Assistant Professor
Icahn School of Medicine at Mount Sinai
New York City
NY
Declarações
MRS declares she has no competing interests.
Agradecimentos
Dr Madeleine R. Schaberg would like to gratefully acknowledge Mr D. Pinder, the previous contributor to this topic.
利益声明
DP declares that he has no competing interests,
同行评议者
Nikita Chapurin, MD, MHS
Assistant Professor
Rhinology, Sinus and Skull Base Surgery
Department of Otolaryngology
University of Florida
Gainesville
FL
利益声明
NC declares that he has no competing interests.
Ethan Cumbler, MD
Assistant Professor
Department of Internal Medicine
University of Colorado Health Sciences Center
Denver
CO
利益声明
EC declares that he has no competing interests.
Samuel J. Stratton, MD, MPH
Professor
UCLA School of Public Health and David Geffen School of Medicine
Los Angeles
Medical Director
Health Disaster Management/Emergency Medical Services
Orange County Health Care Agency
Santa Ana
CA
利益声明
SJS declares that he has no competing interests.
Janet Wilson, BSc, MD, FRCSEd, FRCSEng
Professor of Otolaryngology - Head and Neck Surgery
Newcastle University
Honorary Consultant Otolaryngologist
Freeman Hospital
Newcastle-Upon-Tyne
UK
利益声明
JW declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Womack JP, Kropa J, Jimenez Stabile M. Epistaxis: outpatient management. Am Fam Physician. 2018 Aug 15;98(4):240-5.全文 摘要
Tunkel DE, Anne S, Payne SC, et al. Clinical practice guideline: nosebleed (epistaxis). Otolaryngol Head Neck Surg. 2020 Jan;162(1 suppl):S1-38.全文 摘要
Seikaly H. Epistaxis. N Engl J Med. 2021 Mar 11;384(10):944-51.
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Hemoptysis
- Hematemesis
更多 鉴别诊断指南
- Clinical practice guideline: nosebleed (epistaxis)
- Guideline for management of idiopathic epistaxis in adults
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