Epistaxis, A Management Plan

Epistaxis is common and can start as infrequent episodes.

As the episodes become more frequent, a patient will book an appointment to see you.

Clinical History

A focused history will help identify any risk factors or triggers.

Once those have been dealt with, and no red flags have been identified.

It’s time to act.

Clinical Examination

If there’s a visible bleeding spot or a prominent vessel visible when examining the nose, then nasal cautery is the next step.

Management Plan

However, if you’re not set up to do that, a simple topical nasal cream is the next step in management.

The cream to prescribe is naseptin.

Naseptin is a combination cream made up of chlorhexidine and neomycin and a small amount of peanut oil, an antiseptic and antibiotic that treats any superficial vestibulitis in the anterior nose.

It’s imperative to always check that the patient isn’t allergic to peanuts. If they are, then a suitable alternative is mupirocin.

The patient needs to be shown how to use the cream effectively.

Patient instructions

A small pea-sized amount of the cream is to be applied inside the nose, using a clean little finger. Aiming for the nasal septum bilaterally. Moisturising and treating any superficial infection is worth doing bilaterally.

And then gently pinching the nose to distribute the cream inside the nose.

This is to be performed twice daily for two weeks.

This is an opportune time to reiterate first aid advice in case of further episodes of epistaxis.

Sit down, lean forward, pinch the nostrils together for 15 minutes.

Keeping the mouth open to breath.

Apply an ice pack to the forehead and back of the neck.

If the bleeding doesn't stop after 20 minutes of the above, please attend the Emergency Department (A&E).

Next steps

If the episodes of nosebleeds continue, then a referral is next.