Epistaxis

Epistaxis is bleeding from the vascular nasal mucosa. Most episodes begin anteriorly, usually in the Kiesselbach plexus on the anterior nasal septum. The vessel is often visible, and the bleeding may appear as a steady ooze or a stream from one nostril. Dry air, mucosal irritation, inflammation, and digital trauma can crack this exposed vascular area. Posterior epistaxis arises less commonly from branches of the sphenopalatine artery deeper in the nasal cavity. It is more dangerous because the source may not be visible from the front. Blood may flow directly into the pharynx, producing brisk posterior drainage, swallowing, coughing, aspiration risk, and potentially substantial blood loss. Persistent blood in the posterior pharynx despite appropriate anterior compression is a particularly concerning pattern. The history changes the risk assessment. Anticoagulants and antiplatelet agents make clot formation less effective, while liver disease, platelet disorders, and other coagulopathies can prolong bleeding. Hypertension may sustain or intensify an active bleed, although it does not necessarily initiate the vessel rupture. Recurrent episodes should prompt questions about chronic nasal dryness, topical spray use, structural abnormalities, and bleeding...