Approach Considerations

For the most part, laboratory studies are not needed or helpful for first-time nosebleeds or infrequent recurrences with a good history of nose picking or trauma to the nose. However, they are recommended if major bleeding is present or if a coagulopathy is suspected.

Laboratory Tests

Laboratory tests to evaluate the patient’s condition and underlying medical problems may be ordered depending on the clinical picture at the time of presentation. If the bleeding is minor and not recurrent, then a laboratory evaluation may not be needed.

If a history of persistent heavy bleeding is present, obtain a hematocrit count and type and cross match. If a history of recurrent epistaxis, a platelet disorder, or neoplasia is present, obtain a complete blood count (CBC) with differential. The bleeding time is an excellent screening test if suspicion of a bleeding disorder is present. Obtain the international normalized ratio (INR)/prothrombin time (PT) if the patient is taking warfarin or if liver disease is suspected. Obtain the activated partial thromboplastin time (aPTT) as necessary.

Other Studies

Direct visualization with a good directed light source, a nasal speculum, and nasal suction should be sufficient in most patients. However, computed tomography (CT) scanning, magnetic resonance imaging (MRI), or both may be indicated to evaluate the surgical anatomy and to determine the presence and extent of rhinosinusitis, foreign bodies, and neoplasms. Nasopharyngoscopy may also be performed if a tumor is the suspected cause of bleeding.

Sinus films are rarely indicated for a nosebleed. Angiography is rarely indicated.

Treatment & Management

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Media Gallery

Posterior epistaxis from the left sphenopalatine artery.
Resolved posterior epistaxis after endoscopic cauterization of the left sphenopalatine artery.
Nasal speculum.
Vaseline gauze packing.
Expandable (Merocel) packing (dry).
Nasal vascular anatomy

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Author

Quoc A Nguyen, MD Associate Clinical Professor, Director, Sinus and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Medical Center

Quoc A Nguyen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, Phi Beta Kappa, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, The Triological Society, American Rhinologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children's Hospital, Montreal General Hospital, and Royal Victoria Hospital

Ted L Tewfik, MD is a member of the following medical societies: American Society of Pediatric Otolaryngology, Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Emeritus Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Neosoma; MI10;<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10 advisor.

Additional Contributors

Hassan H Ramadan, MD, MSc, FACS, FARS Professor and Chairman, Director of Rhinology and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc, FACS, FARS is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society

Disclosure: Nothing to disclose.

Epistaxis Workup

Approach Considerations

Laboratory Tests

Other Studies

References

Tables

Contributor Information and Disclosures

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