Epistaxis Management
Aftercare
- Review simple first-aid measures with patient; seek care if bleeding has not stopped after 20 min of first aid measures.
- Review common causes of epistaxis.
- Avoid blowing or picking nose.
- Refrain from heavy lifting or strenuous activity for 1-2 weeks with no evidence of bleeding.
- Use humidifier or nasal saline spray.
- Avoid smoking.
- Sneeze with mouth open.
- Apply topical antibiotic cream or petroleum jelly to nares.
- If packing is in place, do not remove packing.
Follow-up
- Consider referral to otolaryngologist if the patient is under 2 years of age or has underlying disorders that predispose them to bleeding.
- Severe or prolonged epistaxis should have referral to ENT to rule out tumour in nasal cavity.
- Arrange for nasal packing to removed in 2-3 days by ENT.
- Consider lab investigation in presence of recurrent, or persistent heavy epistaxis (CBC, PT/INR, aPTT).
- Educate patient to monitor for fever, bleeding that continues or breaks through packing, severe pain, nausea, or vomiting and to seek immediate care.