Emerg Med Clin North Am. 2019 Feb;37(1):29-39. doi: 10.1016/j.emc.2018.09.005.


Most anterior epistaxis originates primarily from the Kiesselbach plexus, whereas posterior epistaxis is less common and originates from branches of the sphenopalatine artery. Risk factors include local trauma, foreign body insertion, substance abuse, neoplasms, inherited bleeding diatheses, or acquired coagulopathies. Assessment of airway, breathing, and circulation precedes identification of bleeding source, pain control, and achieving hemostasis. Management options include topical vasoconstrictors, direct pressure, cautery, tranexamic acid, nasal tampons, Foley catheters, or surgical intervention. Specialty consultation may be pursued if interventions fail. Disposition is typically to home unless posterior epistaxis or significant comorbidities exist that warrant admission.

Keywords: Anterior epistaxis; ENT emergencies; Epistaxis; Posterior epistaxis; TXA.

Publication types

  • Review

MeSH terms

  • Emergencies
  • Epistaxis / etiology
  • Epistaxis / pathology
  • Epistaxis / therapy*
  • Humans