- Indications: Simple nosebleed. Most cases of epistaxis in children have a
benign etiology. Referral to an otolaryngologist is indicated for
uncontrollable bleeding, posterior epistaxis, hemodynamic instability, or
anatomic abnormalities (e.g., tumors, polyps). See Chapter 14 for
management of epistaxis in patients with hemophilia, von Willebrand
disease, immune thrombocytopenia, or other bleeding disorders. - Complications: Persistent bleeding, swallowing blood, toxic shock
syndrome (from packing material), septal hematomas/abscesses from
traumatic packing, sinusitis - Procedure: The child should sit upright and bent forward at the waist to
minimize swallowing blood. Remove blood clots, which promote
fibrinolysis.
a. Direct compression: Instruct the child or parent to compress the nasal
alae against the septus with two fingers for 5e15 minutes. Most
simple bleeds will clot after 5 to 10 minutes.
b. Topical vasoconstriction: Use oxymetazoline-soaked cotton pledgets
or gauze. Phenylephrine is associated with morbidity when used
topically and should be avoided in patients younger than 6 years of
age. However, if bleeding is refractory to other interventions, the
minimum dose of phenylephrine needed to cease bleeding should be
used. Use a squirt bottle or apply the vasoconstrictor on a piece of
cotton, applying direct pressure on the nose for 5 to 10 minutes.
c. Nasal packing
(1) Apply topical anesthetic on a cotton pledget and insert into the
nasal cavity. Remove after 5e10 minutes.
(2) Rub antibiotic ointment into a quarter-inch ๎ 72-inch gauze
ribbon. Using a nasal speculum or forceps, pack the nasal cavity
by grasping the gauze ribbon approximately 6 inches from its end
and placing the packing as far back as possible. Ensure that the
free end protrudes from the nose and secure with tape.
(3) Maintain packing for 72 hours. If bleeding persists after 72 hours,
packing should be replaced and the child referred to an
otolaryngologist.
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