• Monitor pulse and blood pressure.

    • If bleeding has stopped after this time (as it does in most cases) proceed to inspect the nose using a nasal speculum and consider cautery.

    • If the history is of severe and prolonged bleeding get expert help - and watch carefully for signs of hypovolaemia etc..

  • Nasal Examination - Collect the equipment you will need : lidocaine and phenylephrine spray, headtorch, suction, nasal speculum and silver nitrate cautery sticks.

    • Carefully examine the nasal cavity looking for any bleeding points - which can usually be seen on the anterior septum - either an oozing point or a visible clot. Is there any pus suggesting local bacterial infection?

    • Blowing the nose decreases the effects of local fibrinolysis and removes clots, permitting a clearer examination. Applying a vasoconstrictor before examination may reduce haemorrhage and help locate the bleeding site. A topical local anaesthetic reduces pain from examination and nasal packing. Lignocaine with adrenaline is usual.

    • Apply a silver nitrate cautery sticks for 10 seconds or so, working from the edge and moving radially (see Nasal Cautery article) - never both sides of the septum at the same session. Cautery and cream (Naseptin┬«) are equally effective for the treatment of epistaxis. However the application of a cream-based treatment may initially be is easier and more practical, particularly in children.


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