Epistaxis

Excerpt

Epistaxis (nosebleed) is one of the most common ear, nose, and throat (ENT) emergencies in the emergency department or the primary care clinic. There are 2 types of nosebleeds: anterior (more common) and posterior (less common but more likely to require medical attention). The source of 90% of anterior nosebleeds is within Kiesselbach's plexus (also known as Little's area) on the anterior nasal septum. There are 5 named vessels whose terminal branches supply the nasal cavity.

1. Anterior ethmoidal artery

2. Posterior ethmoidal artery

3. Sphenopalatine artery

4. Greater palatine artery

5. Superior labial artery

These 5 vessels' watershed areas are in the anterior nasal septum, comprising Kiesselbach's plexus. This lies at the entrance to the nasal cavity and is subject to extremes of heat, cold, and high and low moisture; it is easily traumatized. The mucosa over the septum in this area is fragile, making this the site of most epistaxis. More rarely, posterior or superior nasal cavity vessels bleed, leading to the so-called "posterior" epistaxis. This is more common in patients on anticoagulants, patients who are hypertensive, and patients with underlying blood dyscrasia or vascular abnormalities. Management depends on the severity of the bleeding and the patient's concurrent medical problems. See Image. Nosebleed Vessels.