• Epistaxis may be classified as anterior or posterior nosebleeds.
  • Anterior nosebleeds are most common, usually occurring at Kiesselbach’s plexus in the anterior nasal septum.
  • Kiesselbach’s plexus consists of the anterior ethmoid, greater palatine, sphenopalatine, and superior labial arteries.
  • More common in children and adolescents.
  • Commonly caused by trauma, including nose picking.
  • Approximately 10% if epistaxis occurs in the posterior nasal cavity, in an area known as Woodruff’s plexus.
  • Woodruff’s plexus mainly consists of the the posterior nasal, sphenopalatine, and ascending pharyngeal arteries.
  • Usually seen in the elderly.
  • Associated with hypertension and atherosclerosis.
  • Initial management of epistaxis involves positioning the patient leaning forward and applying manual pressure to the anterior nose for 15-20 minutes.
  • Other treatment options include topical decongestants (oxymetazoline), topical anesthetics (lidocaine), cautery (silver nitrate, electrocautery), packing, and surgery consisting of arterial ligation for intractable bleeding.