It is a frequent ED complaint and often promotes significant anxiety in patients and clinicians. Epistaxis is classified as anterior or posterior based upon the primary bleeding site.
Hemorrhage is most commonly anterior, originating from the nasal septum.
A common source of anterior epistaxis is Kiesselbach plexus, an anastomotic network of vessels on the anterior portion of the septum just superior to the posterior end of the nasal vestibule. Bleeding also may originate anterior to the inferior turbinate. Posterior hemorrhage originates in the posterior nasal cavity or nasopharynx, usually below the posterior half of the inferior turbinate or roof of the nasal cavity. Mortality is rare and usually is due to complications from hypovolemia, with severe hemorrhage or underlying disease states. Increased morbidity is associated with nasal packing.