Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- blood at both sides of nose
Otros factores de diagnóstico
- 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
Factores de riesgo
- 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
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- clinical diagnosis
Pruebas diagnósticas que deben considerarse
- 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 tratamiento
active epistaxis: initial measures
active epistaxis: persistent bleeding precluding identification of bleeding site
active epistaxis: bleeding site visible
quiescent but recurrent epistaxis
Colaboradores
Consejeros especializados
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
Divulgaciones
MRS declares she has no competing interests.
Agradecimientos
Dr Madeleine R. Schaberg would like to gratefully acknowledge Mr D. Pinder, the previous contributor to this topic.
Divulgaciones
DP declares that he has no competing interests,
Revisores por pares
Nikita Chapurin, MD, MHS
Assistant Professor
Rhinology, Sinus and Skull Base Surgery
Department of Otolaryngology
University of Florida
Gainesville
FL
Divulgaciones
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
Divulgaciones
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
Divulgaciones
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
Divulgaciones
JW declares that she has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Womack JP, Kropa J, Jimenez Stabile M. Epistaxis: outpatient management. Am Fam Physician. 2018 Aug 15;98(4):240-5.Texto completo Resumen
Tunkel DE, Anne S, Payne SC, et al. Clinical practice guideline: nosebleed (epistaxis). Otolaryngol Head Neck Surg. 2020 Jan;162(1 suppl):S1-38.Texto completo Resumen
Seikaly H. Epistaxis. N Engl J Med. 2021 Mar 11;384(10):944-51.
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Hemoptysis
- Hematemesis
Más DiferencialesGuías de práctica clínica
- Clinical practice guideline: nosebleed (epistaxis)
- Guideline for management of idiopathic epistaxis in adults
Más Guías de práctica clínicaVideos
Venepuncture and phlebotomy: animated demonstration
Insertion of an anterior nasal pack
Más vídeosFolletos para el paciente
Nosebleeds in children
Nosebleeds (epistaxis) in adults
Más Folletos para el paciente
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