epistaxis /ep′istak″sis/ [Gk, a dropping] , bleeding from the nose caused by local irritation of mucous membranes, violent sneezing, fragility or manipulation of the mucous membrane, chronic infection, trauma, hypertension, coagulopathy, vitamin K deficiency, or thrombocytopenia. Also called nosebleed. ▪ OBSERVATIONS: Epistaxis may result from the rupture of tiny vessels in the anterior nasal septum. This occurs most frequently in early childhood and adolescence. In adults it occurs more commonly in men than in women; may be severe in elderly persons; may be accompanied by respiratory distress, apprehension, restlessness, vertigo, and nausea; and may lead to syncope. ▪ INTERVENTIONS: The patient suffering epistaxis is instructed to breathe through the mouth, to sit quietly with the head tilted slightly backward. The bleeding may be controlled by inserting a cotton ball soaked in a topical vasoconstrictor and applying pressure to the skin on both sides of the nose, occluding the blood supply to the nostrils; or by placing an ice compress over the nose. The nasal mucosa may be anesthetized with topical lidocaine, cauterized with a silver nitrate stick or an electrical cautery, and then sprayed with epinephrine. Severe bleeding, especially from the posterior nasal septum, may be treated by packing, which is left in place for 1 to 3 days. Persistent or recurrent profuse epistaxis may be treated by ligating an artery supplying the nose, such as the external carotid, ethmoid, or internal maxillary artery.
