- Sit the patient up to avoid aspiration of blood
- Pinch the nose for 10-20 minutes
- Apply ice or cold pack on the bridge of the nose
##Packing the nose with paraffin pack:
- Remove clots with suction catheter
- Apply xylocaine nasal spray AVOIDING the use of adrenaline
(NB: Some literature still advocate for the use of topical adrenaline in treatment of epistaxis)
- Prepare a length of ribbon gauze impregnated with petrolatum jelly
- Use bayonet forceps or Tiley’s forceps and a nasal speculum to place the gauze in a layered, accordion fashion, packing it from anterior to posterior (from the floor to the roof).
- Remove the pack after 24 - 48hrs
- Toxic shock syndrome can occur in rare cases.
##Cauterization of the nose:
- This is recommended after a specific bleeding point is identified and the bleeding has stopped
- It is done under local anesthesia
- The tip of a silver nitrate stick is rolled over nasal mucosa until a gray eschar forms.
- Cauterize only one side of the septum at a time to prevent septal necrosis or perforation
- Thermal cauterization (under local or general anesthesia) is only used for more serious bleeding.
## For patients with significant hemorrhage:
- Set the IV line and administer crystalloid infusion while monitoring functions and pulse oximetry
##Other forms of management
- Arterial ligation (in treatment of resistant epistaxis)
- Embolization (in treatment of resistant epistaxis)
##Treatment of underlying causes