epistaxis

Epistaxis, commonly known as a nosebleed, is bleeding from the nasal cavity. It is a frequent medical problem that brings patients to urgent care and emergency departments. Most episodes originate from the anterior part of the nasal septum (Kiesselbach's plexus) and stop spontaneously or with simple first aid; posterior bleeds are less common but more severe.

Causes include local trauma, dry or crusty nasal mucosa, rhinitis, infections, foreign bodies, and allergic conditions. Systemic factors such as anticoagulant or antiplatelet medications, alcohol use, and rarely hypertension can increase bleeding risk. Posterior epistaxis, arising from branches of the sphenopalatine artery, tends to be more difficult to control.

Initial management focuses on stopping the bleed and preventing aspiration. The patient should sit up and lean forward, and the bleeding nostril should be pinched closed for about 5–10 minutes while breathing through the mouth. A cold compress and avoidance of nose blowing help. If bleeding does not stop, or if frequent episodes occur, medical evaluation is needed. Examination may include visual inspection and nasal endoscopy; tests may assess bleeding disorders and medication effects.

Treatment for anterior bleeds commonly involves topical vasoconstrictors and/or chemical cautery of active bleeding sites. Anterior nasal packing may be used if bleeding persists. Antibiotics are considered if packing is left in place. Posterior bleeds may require larger packing, hospitalization, and rarely surgical ligation or embolization.

Prevention focuses on keeping the nasal passages moist, avoiding trauma, and reviewing medications with a clinician. Most epistaxis resolves without long-term problems; recurrence is common but usually manageable with proper care.