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Clinical Practice Guideline: Nosebleed (Epistaxis).

David E Tunkel1, Samantha Anne2, Spencer C Payne3

  • 1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|January 8, 2020
PubMed
Summary
This summary is machine-generated.

Nosebleeds (epistaxis) are common, with guidelines recommending prompt management for severe cases. This includes sustained nasal compression, appropriate packing, and identifying bleeding sources to improve patient outcomes and reduce care variations.

Keywords:
epistaxishereditary hemorrhagic telangiectasia (HHT)nasal cauterynasal packingnosebleed

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Area of Science:

  • Otolaryngology and Emergency Medicine
  • Clinical Guideline Development

Background:

  • Nosebleeds (epistaxis) affect a significant portion of the population, with a subset requiring medical attention.
  • Management of epistaxis ranges from home care to intensive procedures, highlighting the need for standardized best practices.

Purpose of the Study:

  • To identify quality improvement opportunities in nosebleed management.
  • To provide clear, actionable recommendations for clinicians to standardize care and improve patient outcomes.
  • To reduce variations in the treatment of epistaxis across different clinical settings.

Main Methods:

  • Development of a multidisciplinary guideline based on evidence-based quality improvement opportunities.
  • Focus on common presentations of epistaxis in ambulatory, emergency, and inpatient settings.
  • Inclusion of first-line treatments (e.g., nasal packing, cautery) and advanced procedures (e.g., arterial ligation, embolization).

Main Results:

  • Recommendations include distinguishing patients needing prompt management, using sustained nasal compression, and appropriate nasal packing (resorbable for specific patient groups).
  • Emphasis on patient education regarding packing, post-procedure care, and preventive measures.
  • Guidelines for identifying bleeding sources via rhinoscopy and endoscopy, and managing recurrent or severe epistaxis with advanced interventions.

Conclusions:

  • Implementation of these evidence-based recommendations can optimize the diagnosis, treatment, and prevention of nosebleeds.
  • The guideline aims to enhance clinical practice, improve patient health outcomes, and minimize potential harms associated with epistaxis and its treatments.