Question

A 20-year-old male comes to the casualty with complaints of bleeding from nose for the last one hour. 
How will you manage a case of epistaxis? 
 

Hint:

For recurrent or severe epistaxis, nasal packing or cauterization can be life-saving. In severe cases, consider the need for surgical intervention or arterial embolization.

Answer 1

Step 1: Initial Management.
- Pinching the Nostrils: Instruct the patient to pinch their nostrils together for 10-15 minutes. This compresses the blood vessels and can help stop the bleeding. The patient should lean forward to avoid blood going into the throat.
- Apply Ice Pack: Applying an ice pack to the nose and back of the neck can help constrict blood vessels and reduce bleeding.

Step 2: Pharmacological Treatment.
- Nasal Decongestants: Topical nasal decongestants (e.g., oxymetazoline) can be used to constrict blood vessels and control the bleeding. These should only be used for short periods.
- Cauterization: If bleeding persists, cauterization of the bleeding vessel can be done using silver nitrate or electrical cautery to seal the blood vessel. This is most effective for anterior bleeds.

Step 3: Nasal Packing.
For persistent or severe bleeding, nasal packing may be required. This involves inserting a gauze or a balloon catheter into the nasal cavity to apply pressure to the bleeding site. The packing should be left in place for 24-48 hours, and antibiotics may be given to prevent infection.

Step 4: Surgical Intervention.
In rare cases, if all other methods fail, surgical intervention such as ligation of the internal carotid artery or arterial embolization may be necessary, particularly for posterior bleeds.

Step 5: Conclusion.
Management depends on the severity of the bleeding. Conservative measures such as pinching the nostrils and decongestants are effective in many cases, but more severe or recurrent cases may require cauterization, packing, or surgery.