Management of anterior and posterior epistaxis.

Management of epistaxis is directly related to the site of the bleeding. Anterior nosebleeds are the least dangerous and the most common, especially among children. Sinus disease, colds, allergies, abrupt temperature changes and dry heat produce fragile and hyperemic nasal mucosa that bleeds easily with nose blowing or mild abrasion. Anterior epistaxis can be reached easily and stopped by pinching the nostrils, applying silver nitrate cautery or lightly packing the anterior nose. Posterior epistaxis may be severe and may be more difficult to locate and control. Occurring more often in the elderly, posterior nosebleeds are frequently associated with hypertension, atherosclerosis and conditions that decrease platelets and clotting function. Visualization of the bleeding site is enhanced by proper positioning of the patient, use of topical vasoconstricting anesthesia and suctioning. Anterior and posterior nasal packing, hospitalization, antibiotics and close follow-up may be required to control posterior nosebleeds.