GPAtlas🧭 When to suspect
Epistaxis is bleeding from the nasal cavity.
• It is extremely common – around 60% of people experience it at some point.
• Most episodes are minor, self-limiting, and managed entirely in the community.
It has a bimodal age distribution:
• Children (typically 2–10 years), usually from digital trauma
• Adults over 50, who are more often anticoagulated
Distinguish anterior from posterior bleeds:
• The great majority are anterior bleeds arising from Little's area (Kiesselbach's plexus) on the anterior septum, where fragile vessels are easily disrupted
• Posterior bleeds are far less common but more dangerous: they arise from deeper sphenopalatine artery branches, occur more often in older patients, are heavier, harder to control, and carry a risk of airway compromise and significant blood loss
The two key skills in primary care are to deliver correct first aid (which stops most bleeds) and to recognise the minority who need escalation:
• The haemodynamically unstable
• The uncontrolled or posterior bleed
• The persistent unilateral symptom pattern that may signal sinonasal pathology
| Feature | Anterior bleed | Posterior bleed |
|---|---|---|
| Source | Little's area (Kiesselbach's plexus) | Sphenopalatine artery branches |
| Frequency | The large majority | A small minority |
| Typical patient | Children, younger adults | • Older adults • Often anticoagulated |
| Clues | • Visible anterior point • Usually one nostril |
• Profuse • Blood down the throat • Both nostrils |
| Action | First aid ± cautery or antiseptic cream | Often needs ENT – packing, admission |
Source: ENT UK
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