Clinical Practice Guideline: Nosebleed (Epistaxis)

@article{Tunkel2020ClinicalPG,
 title={Clinical Practice Guideline: Nosebleed (Epistaxis)},
 author={David E Tunkel and Samantha Anne and Spencer C Payne and Stacey L. Ishman and Richard M. Rosenfeld and Peter J. Abramson and Jacqueline D. Alikhaani and Margo McKenna Benoit and Rachel S Bercovitz and Michael D. Brown and Boris Chernobilsky and David A. Feldstein and Jesse M. Hackell and Eric H. Holbrook and Sarah M. Holdsworth and Kenneth Weicong Lin and Meredith Merz Lind and David M. Poetker and Charles A. Riley and John S. Schneider and Michael D. Seidman and V. P. Vadlamudi and Tulio A. Valdez and Lorraine C. Nnacheta and Taskin M. Monjur},
 journal={Otolaryngology–Head and Neck Surgery},
 year={2020},
 volume={162},
 pages={S1 - S38},
 url={https://api.semanticscholar.org/CorpusID:210072781}
}
This guideline addresses the diagnosis, treatment, and prevention of nosebleed and discusses first-line treatments such as nasal compression, application of vasoconstrictors, nasal packing, and nasal cautery.

140 Citations

Risk Factors for Severe Clinical Course in Epistaxis Patients.
Epistaxis is significantly more common and severe in older male patients with hypertension or antiplatelet/anticoagulation therapy, however, few need a blood transfusion or surgical intervention, and these factors are suggested as indications for hospitalization due to their marked influence on the clinical course.

Ear, Nose, and Throat Emergencies: Diagnostic Evaluation, Assessment of Urgency, and Treatment.
The rising number of patients presenting to emergency rooms presents a challenge to all affected areas of the health care system, and the "red flags" presented in this article can serve as an initial guide to ENT emergencies.

Risk Factors and Management for Epistaxis in a Hospitalized Adult Sample
Identifying at-risk patients for epistaxis at hospital admission can help to initiate measures to prevent epistaxis episodes, and common risk factors for and management of epistaxis in patients admitted for other medical conditions are demonstrated.

Epistaxis: aspectos nuevos a considerar
Novel aspects in the evaluation, study and mana- gement of epistaxis, which include the use of tranexamic acid and new intranasal devices are summarized.

Anterior Epistaxis in a Patient with a History of Allergic Rhinitis: A Case Report
Anterior epistaxis can occur as a complication of chronic allergic rhinitis, and the diagnosis established through anamnesis, physical examination, and supporting tests is consistent with the theory outlined in the literature review.

Treatment, Management, and Otolaryngology Consultation for Epistaxis in the Emergency Room: An Institutional Experience
The high percentage of patients referred or transferred to the ED for epistaxis management with no change in interventions after ENT consultation indicates a continued need to develop more precise clinical care pathways.

Clinical Recommendations for Epistaxis Management During the COVID-19 Pandemic
A simple memorandum of clinical recommendations to minimize the risk of operator infection deriving from epistaxis management is proposed and the use of filtering masks is strongly recommended since all patients, including those referring for epistaxis, should be treated as being COVID-19 positive in the emergency department.

Plain Language Summary: Nosebleed (Epistaxis)
This plain language summary explains nosebleeds, also known as epistaxis (pronounced ep-ih-stak-sis), to patients to help patients ask questions and make decisions in their own care.
...

165 References

Management of epistaxis.
Treatments to be considered include topical vasoconstriction, chemical cautery, electrocautery, nasal packing, posterior gauze packing, use of a balloon system, and arterial ligation or embolization.

A change in UK epistaxis management
After careful assessment and provided that nasal packing properly performed and advice sheet is given and understood, it is safe to manage patients with routine epistaxis at home, which is a change to the current standard UK management.

Tranexamic acid for patients with nasal haemorrhage (epistaxis).
The pooled result demonstrated a benefit of tranexamic acid compared to placebo, the risk of re-bleeding reducing from 67% to 47% and the quality of evidence provided by the single study as low, therefore it is uncertain whether topical tranExamic acid is effective in stopping bleeding in the 10-day period after a single application.

Interventions for recurrent idiopathic epistaxis (nosebleeds) in children.
High quality randomised controlled trials comparing interventions either with placebo or no treatment, and with a follow-up period of at least a year, are needed to assess the relative merits of the various treatments currently in use.

Epistaxis, Medical History, and the Nasopulmonary Reflex: What is Clinically Relevant?
The nasopulmonary reflex, as previously described in terms of a primary drop in O2, therefore seems clinically irrelevant and early surgery for posterior epistaxis is not warranted on the basis of maintenance of adequate oxygenation alone.
...