Epistaxis cared by emergency physicians in emergency department

Epistaxis is a common pathological condition. Although many patients visit the emergency department complaining of epistaxis, epistaxis is typically treated by otolaryngologists. At Keio University Hospital, emergency physicians care for all epistaxis patients transported by ambulance and otolaryngologists are consulted as needed. The aim of the present study was to examine the characteristics of patients with non-traumatic epistaxis, especially difficult-to-control bleeding and patients in shock, and to further clarify the role of emergency physicians in the first-line management of epistaxis. We identified patients transported by ambulance to Keio University Hospital for the treatment of non-traumatic epistaxis between January and October 2012 and collected the patients ’ clinical records retrospec-tively. As a result, 208 patients with non-traumatic epistaxis were identified. Elderly and male patients were predom-inant. Most of the patients (170 patients, 81.9%) had placed a call for emergency service at night between 17:00 to 8:00, and the transportation time ranged from 3 to 55 minutes (median, 20 minutes). Otolaryngologists were consulted in 31 cases (14.9%) because of difficult-to-control bleeding. In this group, patients had a tendency to be tak-ing anticoagulant and/or antiplatelet medications vs. p = Nine patients were shock. the emergency department within 24 hours because of a relapse of epistaxis. In conclu-sion, the relatively low rate of otolaryngologist consultations and the low rate of return visits suggest that the involvement of emergency physicians in first-line care for epistaxis is safe and efficient for the patients. Moreover, the involvement of both emergency physicians and otolaryngologist specialists enabled the safe treatment of patients who were in shock.