Only 10% of epistaxis requires treatment from an otolaryngologist.  You should refer to an otolaryngologist when bleeding is refractory to treatment.  The surgeon may perform arterial ligation, endoscopic cautery, or embolization.  If a posterior bleed is suspected, referral to an otolaryngologist is done for treatment with a posterior pack, Foley catheter, balloon catheter, or Merocel sponges.  Finally, patients with complications resulting from packing such as septal hematomas, abscesses, or pressure necrosis should also be seen by an otolaryngologist.

You're All Done!

In summary, epistaxis can be a potentially life threatening problem. It is important for you to determine whether your patient is acutely ill and know the appropriate management. Have an approach to determining the cause of epistaxis. Remember that most cases of epistaxis have no known cause. A thorough physical exam can help identify the site of the bleed and can also identify systemic diseases that can cause epistaxis. Also remember that anterior nasal packing can be done if you cannot cauterize the vessel but you suspect an anterior bleed. Finally, remember that although the family physician can manage 90% of epistaxis, it is important to know that the GP should refer to a specialist when epistaxis becomes refractory to medical treatment.

You have completed the Epistaxis Case!