Epistaxis (Nosebleeds)

🔍 When to Suspect

Active bleeding from one or both nostrils, requiring assessment of severity, frequency, and potential underlying causes

From the full topic in The Ocean Library: Epistaxis (Nosebleeds)

🧭 When to suspect

Epistaxis is bleeding from the nasal cavity. It is extremely common – around 60% of people experience it at some point – with a bimodal age distribution: children (typically 2–10 years, usually from digital trauma) and adults over 50, who are more often anticoagulated. Most episodes are minor, self-limiting, and managed entirely in the community.

The single most useful clinical distinction is anterior versus posterior. 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, and 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 / antiseptic cream	Often needs ENT – packing, admission

Source: ENT UK

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