Epistaxis Management

José is the son of Mr Garcia who has been admitted for severe epistaxis. Attempts at cautery and then nasal packing have failed. He is going to the operating theatre for an SPA ligation and has given you permission to tell his son about the operation.


  • WIPER  (wash hands, introduce yourself, permission, expose patient, reposition)
  • Ask if he is happy to see you
  • Ask if wants any family/friends present


  • Recap on past events – his knowledge of his father’s admission, past medical history and drug history. 


  • “Can I explain your father’s management and the surgery to you now?”


  • Describe admission
    • Failed cautery
    • Failed packing
    • Next step on ladder is surgery
  • Surgery needs to be done a life-saving procedure
  • Can take between 20-60 minutes
  • Aim is to clip or burn a blood vessel that supplies most of the nose on the side of the bleeding
  • Generally quite a successful procedure with minimal long term sequelae
  • However there is a risk of re-bleeding and palatal numbness
  • Should be able to go home next day providing bloods ok and medically fit


  • “I can see you are quite concerned”

Strategy and Summary

  • Summarise consultation. Today we have talked about…. 
  • Offer chance to ask final questions
  • Offer leaflet on SPA ligation
  • Once again my name is…
  • Secretary number
  • Offer follow-up conversation once father is out of theatre
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