Epistaxis Causes Local Causes Systemic Causes Nasal irritation Nose picking -> most common cause Foreign intranasal body Dry nose -> rhinitis sicca CPAP therapy Bleeding disorders Vascular malformations Von Willebrand disease Hereditary haemorrhagic telangiectasia Severe thrombocytopenia Inflammatory/granulomatous disorders Vascular causes Allergic rhinitis Hypertension Craniofacial trauma Anti-coagulants Blunt trauma e.g. fist punch to the hose Nasal and septal fractures Tumours of the nasopharynx and/or paranasal sinuses Juvenile nasopharyngeal angiofibroma Treatment and Management Immediate management Stabilise the patient using the ABCDE approach including: Immediate hemodynamic support. Keep the patient’s head elevated and tiled forward. Control bleeding by applying uninterrupted bilateral pressure. Pinch the nasal ala against the nasal septum for 15 to 20 minutes. Management of ongoing bleeding For anterior epistaxis with the bleeding site identified: Topical vasoconstrictors e.g. oxymetazoline and/or phenylephrine. Nasal cautery If the bleeding persists or the bleeding site cannot be identified, place nasal packing. For refractory or recurrent bleeding: Consider atrial embolization or endoscopic ligation of the bleeding vessel i.e. sphenopalatine artery or posterior epistaxis.