WhatEp isistaxis an Epistaxis? (nose bleed)

Epistaxis is the medical word for a nose bleed. It is a common problem, usually involving minor bleeding, but it can be very severe and require admission to hospital.

The common causes Idiopathic Epistaxis or “nosebleed without any obvious cause” In children the bleeding is usually minor requiring pressure over the soft part of the nose but in adults the bleeding can be severe and may not stop with simple measures (see overleaf).

Other causes 1. Drug induced: People taking anticoagulant (blood-thinning) or cytotoxic (chemotherapy) drugs may have nose bleeds. 2. Nose-picking. 3. Following nasal surgery. 4. Traumatic injury to the nose or face.

Treatment of the bleeding The doctor will explain everything he is doing.

Cauterisation Certain bleeding can be stopped by cauterising the vessel with a silver nitrate stick or electro- cautery. The doctor will first spray inside your nose. This spray has an unpleasant smell and it is likely your tongue, lips and throat may feel numb. You may have your blood pressure checked.

After cautery you may well be fit to go home, ensuring you follow this advice leaflet. Following cauterisation you can expect minor bleeding for a few days. The doctor will usually prescribe an antiseptic cream to use for a week. If the bleeding point is further back in your nose, you may need a pack inserted. After nose cauterisation, you should ‘dab’ NOT wipe your nose if necessary.

Nasal Packing If the bleeding persists despite cauterisation, packing may be required. If bleeding still persists with packing, a small balloon(s) will be inserted in your nose and inflated to put pressure on the bleeding vessel. These are only used when absolutely essential. You will be admitted to hospital.

How long will I need to stay in hospital? This will depend on your age and treatment. Packs usually stay in for at least 24 hours and often for 48 hours. After removal you will usually stay a further day. A sick certificate can be issued for work or sickness benefit.

Pain You may have some discomfort following cautery, your nose may drip and feel blocked - this is quite common. Paracetamol may be taken to alleviate any pain.

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You will be given antiseptic cream e.g. naseptin to apply to the walls of your nose which will help reduce crusting. If you have had packs or balloons inside your nose, you may be given a course of antibiotics - it is important to finish the course.

Potential problems once at home What to do if your nose bleeds: 1. Apply ice wrapped in a plastic bag (or a pack of frozen peas) to the back of your neck or the bridge of your nose.(forehead area) 2. Sit down with your head bent forward over a bowl. 3. Pinch the soft fleshy part of your nose between thumb and forefinger for 10 minutes. 4. If bleeding does not stop after 10 minutes, repeat for a further 10 minutes.

If you are bleeding you will need to contact the ENT on call doctor. If you need to attend the hospital out-of-hours (after 5pm weekdays and at weekends) to see the ENT on call doctor and it is safe to travel it is preferable that you go to Eastbourne District General Hospital or your nearest Emergency department if severe bleeding.

If the bleeding is very heavy, do not drive yourself and ask someone to accompany you. If severe and you feel faint and weak, it may be necessary to call and ambulance.

For the week after you nose bleed

AVOID 1. Picking or blowing your nose. 2. Drinking very hot drinks. 3. Hot baths or showers. 4. Smoking heavily or at all if possible. 5. Contact with people who have colds or infections. 6. Drinking alcohol. 7. Bending down, stooping, lifting and strenuous exercise. 8. Constipation and straining. Eat a healthy diet with fibre.

DO 1. Keep to cool drinks. 2. Rest and relax for at least three days. 3. Keep in a cool atmosphere. 4. Apply prescribed cream to your nose. 5. Take gentle exercise. 6. Keep any appointment with your GP if high blood pressure has been suspected to blame.

For female patients If you are on the oral contraceptive pill, remember that some antibiotics alter the effect of the Pill. Extra precautions should therefore be taken until you have completed the first week or your next packet of pills after finishing the course of antibiotics.

Important Information Please remember that this leaflet is intended as general information only. It is not definitive. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please, therefore, always check specific advice on the procedure or any concerns you may have with your doctor. After reading this information are there any questions you would like to ask? Please list below and ask your nurse or doctor. Page 2 of 3

Hand Hygiene In the interests of our patients the Trust is committed to maintaining a clean, safe environment. Hand hygiene is a very important factor in controlling infection. Alcohol gel is widely available throughout our hospitals at the patient bedside for staff to use and also at the entrance of each clinical area for visitors to clean their hands before and after entering.

Other formats This information is available in alternative formats such as large print or electronically on request. Interpreters can also be booked. Please contact the Patient Advice and Liaison Service (PALS) offices, found in the main reception areas:

Conquest Hospital Email: [email protected] - Telephone: 01424 758090 Eastbourne District General Hospital Email: [email protected] - Telephone: 01323 435886

After reading this information are there any questions you would like to ask? Please list below and ask your nurse or doctor.

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Reference The following clinicians have been consulted and agreed this patient information: Mr Simon Baer, Consultant (ENT Surgeon) Mr Nicholas Violaris, Consultant (ENT Surgeon) Chin Barton, ENT Nurse Practitioner

Next review date: March 2018 Responsible Clinician: Mr Simon Baer, Consultant (ENT Surgeon)

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