Epistaxis (Nose Bleed)

Description

Diagnostic criteria

General and supportive measures

Medicine treatment

Referral

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ICD-10 code: R04.0

DESCRIPTION

Nose bleed may be caused by local or systemic diseases, or local trauma, especially nose picking and contact sports. It occurs from an area anterior and inferior on the nasal septum. Recurrent nose bleeds should alert one to possible systemic diseases e.g. hypertension and bleeding tendency. Persistent or severe bleeds may require hospital care.

Complications include anaemia and hypovolaemic shock.

DIAGNOSTIC CRITERIA

• History of spontaneous and/or recurrent nose bleeds.
• Underlying problems include bleeding disorders and local intranasal pathology.
• Examine child for nasal lesions and signs of haematological disease and coagulopathies.

GENERAL AND SUPPORTIVE MEASURES

Digital pressure

• Squeeze the nasal wings (alae) of the nose between the thumb and forefinger to apply pressure to the nasal septum and maintain pressure for about 10 minutes.
• The child should sit up and lean forward so as not to swallow the blood, and should breathe through the mouth.
• If digital pressure fails, remove blood clots from the nose. The child may be able to do this by blowing his/her nose. 

MEDICINE TREATMENT

Vasoconstrictor

If digital pressure fails:

• Oxymetazoline 0.025%, nose drops, instil 1–2 drops into the affected nostril(s) and repeat digital pressure as above.

Nasal pack

If bleeding continues and appears to originate from the anterior nasal cavity, pack the nasal cavity (rather than the apex) with cotton gauze tape impregnated with:

• BIPP (bismuth iodoform paraffin paste)

Apply topical anaesthesia to packing material:

• Lidocaine spray 2% solution.
  • Do not exceed 3 mg/kg/dose applied topically.

Anaemia

If symptomatic anaemia:

• haemoglobin is less than 8 g/dL and/or haematocrit is < 25% with ongoing epistaxis, or
• there is an underlying disorder in which severe re-bleeding is likely.
  • Packed red cells, IV, 10–15mL/kg over 2 to 4 hours.

Treat the underlying disorder appropriately.

REFERRAL

• Epistaxis caused by a serious underlying disorder.
• Epistaxis that is not controlled by the above measures.
• Recurrent epistaxis.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 17: Ear Nose & Throat, 17.4 Epistaxis (Nose Bleed)