Pediatric emergency medicine trisk 0567 0567
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Rarely are nosebleeds in children life-threatening or require more than simple
measures to gain control of hemorrhage. However, one’s evaluation should begin
with hemorrhage control and identification of children who are unstable by noting
alterations in the patient’s general appearance, vital signs, airway, color, and
mental status (see Chapter 10 Shock ). Steady pressure and efforts to calm the
child and family often provide sufficient treatment. The child can sit on a parent’s
lap with the head tilted slightly forward, and using some distraction such as a toy
or video, the adult can provide pressure to the anterior nose for 5 to 10 minutes to
achieve hemostasis. This is usually effective since most bleeding in children is
from the anterior nasal septum, but may be helped by the use of a cotton (dental)
roll under the upper lip to compress the labial artery. The addition of cotton
pledgets moistened with a few drops of oxymetazoline (Afrin) or epinephrine
(1:1,000), will occasionally be required to help achieve hemostasis. Topical
hemostatic agents are gaining in popularity for recalcitrant adult epistaxis, with
new data emerging in children. Persistent bleeding may require cautery of a
unilateral, anterior bleeding site with a silver nitrate stick, or in more severe
cases, nasal packing or the use of expandable nasal tampons (see Chapter 130
Procedures sections on Nasal Cauterization and Nasal Packing—Anterior and
Posterior). Patients who require nasal tampons face the risk of toxic shock
syndrome and so typically need antibiotics and ENT follow-up. More severe
epistaxis may require surgical or angiographic intervention (see Figure 118.9 in
ENT Emergencies, Algorithm for the management of epistaxis).
