Any blood being swallowed, or sensation of blood in the pharynx
PMHx e.g. previous nasal surgery, hypertension, sinusitis
Recent URTI/rhinitis, TB, sarcoid, wegeners', nose picking, septal defects
Drug history e.g. antihypertensives, steroid nose drops/sprays, aspirin / warfarin
cocaine, sympathomimetic nose drops, xylometazoline, ephedrine
Points to note on examination
Any airway compromise?
Pulse, BP, capillary refill
Side of bleed
Presence of obvious bleeding point in Littles' area
Blood in oropharynx/ blood being coughed up or fresh haematemesis
Epistaxis can be life threatening
All patients must have baseline observations carried out
Rapid primary survey then more detailed history and examination
Patients should be and be reassessed regularly
To examine the nose, if there is clot blocking your view, ask the patient to gently blow the nose, one nostril at a time to clear it. Then, gently, elevate the tip of the nose with one finger, whilst shining a torch into the nasal antrum. This should allow a view of Littles' area. Thudicums may be used, and are available in nasal packing packs, or ENT emergency packs.
Any septal deviation should be noted, as well as bony deformity on external inspection (especially in the case of traumatic epistaxis).
The oropharynx should be visualised with a tongue depressor and torch.
Suit up! "3 Gs": gloves, gown, and goggles.
Resuscitate your patient first if necessary.
Quick but comprehensive history (left).
The patient should be sitting up and bending slightly
forwards to prevent blood from tracking into the pharynx.