Posterior epistaxis represents only 5 percent of nosebleeds presenting to the ED. 3 It is more common in elderly patients and is believed to be due to arteriosclerosis of the large posterior vessels of the nasal cavity. Hypertension is also a large contributor to posterior epistaxis. One study reported that 64 percent of patients with posterior epistaxis had a previous diagnosis of hypertension. Forty-eight percent were actually hypertensive with a systolic blood pressure (BP) greater than 180 or diastolic greater than 110 at the time of their epistaxis. The most common site of bleeding is posterior to the inferior turbinate, occurring 6 to 7.5 cm posterior to the vestibule, and emanates from branches of the sphenopalatine artery.4 The actual bleeding site usually cannot be visualized.
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