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Medical

EPISTAXIS

Signs and Symptoms: Differential Diagnosis:
• Bleeding From One or Both Nares • Trauma
• Pain • Infection
• Nausea/Vomiting • Allergic/Chemical Rhinitis
• Nasal Deformity • Nose Picking
• Lesions (Polyp, Ulcer)
• Hypertension
• Anticoagulant Therapy
• Thrombocytopenia (ITP)

Universal Patient Care Guideline
Continued from: O2 (if Hypoxemic)
Tactical Evacuation Guideline IV/IO Guideline (prn)
Cardiac Monitor (prn)
Have Patient Blow Nose to
Evacuate Clots
Afrin Nasal Spray (*see Pearls)

Compression (Pinch) and Tilt
Head Forward x 10min
Hypotension? Assess BP and Pulse Hypertension?
Tachycardia?
Normotensive
Blood Product Consider:
(as available) OR Ondansetron 4-8mg IV HYPERTENSION Guideline
(nausea from swallowed blood)
500mL IVF IV prn
When appropriate, return to:
Tactical Evacuation Guideline

Pearls:
• *Avoid Afrin in patients who have a diastolic blood pressure >110 or known coronary
artery disease.
• It is better to overestimate the amount of blood lost with epistaxis.
• Anticoagulants including aspirin, ibuprofen, and even herbals (ginseng) can lead to
increased bleeding.
• Firm pressure should be applied for compression. Pressure should not be applied over the
bridge of the nose, but instead under the bony portion to effectively compress vessels. Do
not release pressure prior to the 10 minutes mark to check bleeding.
• Hypertensive patients will often not stop bleeding until BP is controlled.
• Re-bleeding is common with epistaxis.

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