Clinical Management of the Patient Presenting with Epistaxis Urgent message: Though patients with posterior and bilateral epis- taxis should be admitted to the hospital, the vast majority of epis- taxis episodes can be treated safely and effectively in the urgent care setting. Nathaniel Arnone, MD, Samuel M. Keim, MD, MS, and Peter Rosen, MD Introduction pistaxis is a common presenting complaint, with 15 per 10,000 peo- ple requiring medical attention each year. 1 While the presence of blood in the pharynx can cause concern for both pa- tients and the medical per- sonnel treating them, the vast majority of epistaxis episodes can be successfully managed during the pre- senting episode, and will not require admission or specialty consultation. © John Bavosi / Photo Researchers, Inc. E Anterior vs. Posterior Origin It is useful to classify epistaxis as either anterior or pos- terior in origin. Ninety percent of all epistaxis episodes are anterior, and can usually be managed successfully with a combi- w w w. j u c m . c o m nation of direct pressure, topical vasoconstrictors, cautery, and packing. 2 Most commonly, anterior epis- taxis involves Kiesselbach’s plexus, the area of vascular anastomoses of branches from the superior labial ar- tery, the greater palatine ar- tery, the anterior ethmoid artery, and the sphenopala- tine artery (Figure 1.) Posterior epistaxis usu- ally arises from the spheno- palatine artery. Even if the bleeding appears controlled with a posterior pack, these patients require hospital admission. They have a high rate of recurrent bleeding, as well as the potential for the major compli- cations of the posterior pack, e.g., apnea, purulent si- nusitis, and superior sagittal venous plexus thrombosis. Children rarely have a posterior bleed. Their epistaxis JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | O c t o b e r 2 0 0 8 13