HNY Policy and Pathway Repository - Humber

Epistaxis is defined as an acute haemorrhage from the nasal cavity (unilateral or bilateral).

Most epistaxis is self-limiting and harmless, and often the cause of damage to the blood vessels is not identified.

Local causes of damage to the blood vessels include trauma, inflammation, topical drugs (such as corticosteroids), surgery, vascular causes (such as hereditary haemorrhagic telangiectasia and Wegener's granulomatosis), or tumours (such as squamous cell carcinoma).

More general causes of damage include hypertension, atherosclerosis, increased venous pressure from mitral stenosis, haematological disorders, environmental factors, systemic drugs and excessive alcohol consumption.

Exclude Red Flag Symtoms

• Prolonged (>20 minutes) and/or severe acute bleeding with no response to usual measures, such as local pressure and cooling.
• Discharge of large or multiple clots.
• Sickness with or without haematemesis.
• Systemic / cardio-vascular compromise.
• Signs for a possible underlying clotting problem.
• Long standing intermittent bloody discharge for no apparent reason: adults – suspect malignancy, children or other potentially vulnerable patients – suspect foreign body.
• Unusual presentation in children under the age of two years.

No Guidelines on Management Listed

Referral Criteria

• Investigations prior to referral
• Full blood count
• Coagulation screen

Referrals

All referrals should be made via NHS e-Referrals (eRS). Advice and Guidance can also be sought through eRS.

Information To Include 

• Duration and pattern
• Investigations and measures attempted to date
• Current medications including over the counter
• Blood pressure measure

Guidance in Ear Care