Epistaxis
Bleeding from the nasal mucosa, most often from the densely vascular anterior septum, where management escalates in a stepwise fashion from simple first aid to cautery, packing and, rarely, surgery according to where the bleeding source sits and how well it is controlled.
In a nutshell
Most epistaxis arises from Little's area, a superficial confluence of vessels on the anterior septum, which is why direct compression works for most bleeds. Posterior bleeds come from deeper, less accessible vessels in older or anticoagulated patients and need escalation beyond first aid.
Classic presentation
Unilateral nasal bleeding, often after minor trauma or picking, settling with sustained pressure on the soft part of the nose while leaning forward.
Key points
- Little's area (Kiesselbach's plexus) on the anterior septum is the source of most nosebleeds because its mucosa is thin, superficial and exposed.
- Correct first aid means compressing the soft cartilaginous nose, not the bony bridge, for a sustained 10–15 minutes while leaning forward.
- Posterior bleeds are harder to control because the source lies beyond the reach of external pressure and direct vision.
- Management escalates logically: first aid, then cautery of a visible point, then packing, then arterial ligation or embolisation.
- Recurrent unilateral epistaxis, especially with nasal obstruction, warrants further ENT assessment to exclude a structural or neoplastic cause.
First-line investigation
Anterior rhinoscopy to localise the bleeding point and determine whether it is anterior or posterior.
First-line management
First aid: continuous compression of the soft part of the nose for 10–15 minutes while leaning forward.
Exam traps
- Pinching the bony bridge of the nose instead of the soft cartilaginous part is a common technique error that fails to control bleeding.
- Tilting the head back is incorrect: it risks blood being swallowed or aspirated rather than stopping the bleed.
- Posterior epistaxis in an older, anticoagulated patient is higher risk and more likely to need packing or intervention than a simple anterior bleed.
Educational content pending clinical review. Not medical advice.