1. Epistaxis

2. Evaluation and Management History and Physical Exam 1. Evaluating the ABC. 2. Characterize Epistaxis ; amount,length of time, intermittent vs continuous,side,previous episodes,hospitalizations, packing. 3. Medical History and Blood Dyscrasias. 4. Medications: antiplatelet, anticoagulants. 5. Social History: cocaine abuse, alcoholism, smoking. 6. Toxin Exposure: ammonia, gasoline, phosphorus. 7. Other :trauma,high altitude living,allergy, sinusitis, rhinitis, URI

3. Physical Exam patient should sit up with body tilted forward initial attempt to stop bleeding by applying pressure to nasal alae for several minutes decongestant/anesthetic agents. adequate lighting, nasal speculum, forceps, suctions machine,attempt to localize active bleeding (examine for abrasions, foreign bodies, masses, nasoseptal deformities, etc.). general ex. :pale,jaundice, echymosis,melaena, haematurea,haemoptysis for chronic or recurrent epistaxis without an obvious bleeding source patient should undergo an endoscopic exam

4. Investigations: Radiological Lab Tests PT/PTT, bleeding time, liver function tests, creatinine, CBC, type and cross

5. Medical Management Acute Management: * correct hypovolemia (3:1 Rule) * hypertension (antihypertensive agents) * coagulopathy(fresh frozen plasma, platelets, cryoprecipitate) Chronic Management: * hypertonic nasal spray and humidification * long-term medical management of hypertension * antimicrobial ointment to excoriated lesions

6. Surgical Management Cauterization Anterior Nasal Packing Posterior Nasal Packing Embolization Vascular Ligation Septoplasty/Submucous resection