Summary
Definition
History and exam
Key diagnostic factors
- blood at one nostril or on both sides of nose
- presence of risk factors
Other diagnostic factors
- bleeding starting at the nares
- recurrent epistaxis
- septal deviation
- bleeding starting in the throat
- signs of haemodynamic compromise
- intranasal polyp
- telangiectasia
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
Diagnostic investigations
1st investigations to order
- clinical diagnosis
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
Treatment algorithm
active epistaxis: major haemorrhage
active epistaxis: no major haemorrhage
persistent epistaxis despite initial measures
epistaxis resolved
recurrent epistaxis
Contributors
Expert advisers
Alexander Alexiou, MB, BS, BSc, DCH, FRCEM, DipIMC RSEd
Emergency Medicine Consultant
Barts Health NHS Trust
Physician Response Unit Consultant
London’s Air Ambulance
Royal London Hospital
London
UK
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.
Differentials
- Haemoptysis
- Haematemesis
More DifferentialsGuidelines
- Guideline for management of idiopathic epistaxis in adults
- British Rhinological Society multidisciplinary consensus recommendations on the hospital management of epistaxis
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