Emergency management of a stable child with active epistaxis and no predisposing cause

This algorithm provides stepwise guidance to the treatment of epistaxis in hemodynamically stable children with active epistaxis and no predisposing cause. For additional guidance on the management of epistaxis in children with underlying causes such as bleeding disorders, hereditary hemorrhagic telangiectasia, or juvenile nasopharyngeal angiofibroma refer to UpToDate content on epistaxis in children and on hereditary hemorrhagic telangiectasia.

CBC: complete blood count; PT: prothrombin time; PTT: partial thromboplastin time; INR: international normalized ratio; VWF: von Willebrand factor.

* In cooperative and older children, remove clots by having the patients gently blow their nose. Otherwise, remove clots by gentle suction.

¶ Topical vasoconstriction with oxymetazoline (Afrin) is preferred followed by another attempt at direct pressure. The dose of oxymetazoline 0.05% is 1 to 2 squirts into the bleeding side of the nose.

Δ Anterior nasal bleeding is the source of epistaxis in most children; posterior epistaxis is rare.

◊ Resorbable packing is preferred in young children. It is also preferred for all patients with bleeding disorders, hereditary hemorrhagic telangiectasia, thrombocytopenia, or patients receiving anticoagulation. Consultation with an otolaryngologist is usually warranted in children who require nasal packing.

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Emergency management of a stable child with active epistaxis and no predisposing cause