title: Guidelines of the French Society of Otorhinolaryngology (SFORL). First-line treatment of epistaxis in adults.
abstract: OBJECTIVE
  The authors present the guidelines of the French Otorhinolaryngology-Head and Neck Surgery Society (SFORL) on first-line treatment of epistaxis in adults.
  
  
  METHODS
  A multidisciplinary work-group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work-group. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.
  
  
  RESULTS
  In first-line, clearing out blood-clots and bidigital compression are recommended. In case of persistent bleeding, local anesthesia with a vasoconstrictor is essential before nasal diagnostic and therapeutic procedures. When the origin of bleeding is not anterior, nasal endoscopy is an essential procedure, identifying the bleeding site in most cases. In case of active bleeding, cauterization is recommended but is only feasible if the bleeding site is clearly visible. When the bleeding site is not identifiable or the first measures failed, anterior packing may be performed by a non-specialist physician. Epistaxis requires subsequent nasal endoscopy performed by an ENT specialist. Patients should be informed of the measures to be taken in case of epistaxis at home, and the risks associated with the various treatments.
authors: Service d'ORL, hôpital Henri-Mondor - A.-Chenevier, AP-HP, 51, avenue du Maréchal-de-Lattre-Tassigny, 94010 Créteil, France. Electronic address: emilie.bequignon@gmail.com.
authors: E
authors: E
authors: Bequignon
authors: Service d'ORL et chirurgie cervico-faciale, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
authors: B
authors: B
authors: Vérillaud
authors: Service d'ORL et chirurgie cervico-faciale, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France.
authors: L
authors: L
authors: Robard
authors: Service d'ORL et chirurgie cervico-faciale, CHU La Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 5, France.
authors: J
authors: J
authors: Michel
authors: Service d'ORL et chirurgie cervico-faciale, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
authors: V
authors: V
authors: Prulière Escabasse
authors: Service d'ORL et chirurgie cervico-faciale, CHU Gui-De-Chauliac, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
authors: L
authors: L
authors: Crampette
authors: Service d'ORL et chirurgie cervico-faciale, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors: O
authors: O
authors: Malard
mesh_terms: D000328:Adult; D002425:Cautery / Q000379:methods; D004844:Epistaxis / Q000175:diagnosis / Q000628:therapy*; D019317:Evidence-Based Medicine; D005602:France; D006801:Humans; D033183:Interdisciplinary Communication; D007828:Laryngoscopy / Q000379:methods; D010036:Otolaryngology; D010353:Patient Education as Topic; D012955:Societies, Medical; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents
keywords: Anterior packing; Cauterization; Epistaxis; Posterior packing