Referral to an otolaryngologist is appropriate when bleeding is refractory, complications are present, or specialized treatment (balloon placement, arterial ligation, angiographic arterial embolization) is required. Hospital admission should be considered for patients with significant comorbid conditions or complications of blood loss. Topical or systemic antibiotics should be used in selected patients. Treatments to be considered include topical vasoconstriction, chemical cautery, electrocautery, nasal packing (nasal tampon or gauze impregnated with petroleum jelly), posterior gauze packing, use of a balloon system (including a modified Foley catheter), and arterial ligation or embolization. When epistaxis does not respond to simple measures, the source of the bleeding should be located and treated appropriately. Nasal bleeding usually responds to first-aid measures such as compression. Both local and systemic processes can play a role in epistaxis. A directed history and physical examination generally determine the cause of the bleeding.
Although epistaxis can have an anterior or posterior source, it most often originates in the anterior nasal cavity. In rare cases, this condition may lead to massive bleeding and even death. Family physicians frequently encounter patients with epistaxis (nasal bleeding).
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