Geronimo, Arabelle

Guingab, Macy Grace

Gumabon, Karen
Group 2 - Prime 6’ MCC

EPISTAXIS
(DR. ROBERT DY)

1. Where is the common site of epistaxis?

● Most common site of epistaxis is Kiesselbach’s plexus that is located on the anterior
nasal septum, situated in the antero-inferior part of the nasal septum.

2. What are the two types of epistaxis?

● Anterior epistaxis
○ refers to a nosebleed that originates from the anterior (frontal) part of the nose.
Most of the time, cases of anterior epistaxis originate from the Kiesselbach
plexus, which is a vascular network found on the nasal septum, as these arteries
can be easily traumatized.
○ most common type of nosebleed, and usually involves one nostril

● Posterior epistaxis
○ refers to bleeding from the posterior or superior nasal cavity. Most often, it
originates from the Woodruff plexus, which is a vascular network found in the
lateral wall of the nasal cavity.
 ○ usually involves both nostrils. For these types of nosebleeds, the blood may also
flow backwards and uncomfortably get swallowed or coughed up (hemoptysis)

3. If a 47 year old male, hypertensive was brought to your clinic with continuous nose
bleeding. His blood pressure was 190/100. He was spitting out blood as well. How will
you manage this case?

This can be a case of severe epistaxis caused by systemic hypertension .

Management :

● Stop the bleeding

○ Pinch nose with thumb and index finger
○ If bleeding point is located can perform nose cautery
○ Anterior or posterior nasal pack if failed arterial ligation or endoscopic control of
bleeding
● Evaluate if the Hypertension is an Hypertensive urgency or emergency by:
○ Performing second BP reading
○ Evaluating for associated symptoms chest pain, shortness of breath, back pain,
numbness/weakness, change in vision, or difficulty speaking
○ further assessment is recommended to identify cardiovascular risk
○ Drug treatment
● Control systemic hypertension in the future to prevent a recurrent episode of epistaxis
○ Drug maintenance treatment
○ Lifestyle modification
● Correction of any post hemorrhagic anemia by iron therapy