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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 136-140

Knowledge of first aid management of epistaxis among medical interns attending King Fahad Armed Forces Hospital in Saudi Arabia


1 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; College of Graduate Health Sciences, University of Tennessee health Science Center, Memphis, Tennessee, USA
2 College of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
3 Department of Pediatrics, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia

Date of Submission01-Jun-2020
Date of Decision22-Jun-2020
Date of Acceptance22-Jul-2020
Date of Web Publication19-Aug-2020

Correspondence Address:
Ahmed Abu-Zaid
College of Medicine, Alfaisal University, Riyadh

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_68_20

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  Abstract 


Aim: The aim of this study is to explore the knowledge of medical interns about first aid in the management of epistaxis. Materials and Methods: An anonymous, cross-sectional, and validated survey-based study was conducted in January 2020 at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. Results: A total of 57 medical interns responded to the survey. The vast majority of survey respondents were male (78.9%) and single (80.7%). Around 57.9% of the respondents declared that epistaxis is regarded as one of the emergency situations. A sum of 71.9% of medical interns correctly identified “finger nail trauma” as the most common cause of epistaxis. In addition, while 71.9% of medical interns correctly answered, “sitting with head tilted forward” as the proper management position for a patient with epistaxis, only 52.6% of medical interns correctly answered, “pinching the lower cartilaginous part of the nose” as the primary measure to stop epistaxis. When medical interns were asked about what to do if the patient continued to bleed from the nose in the emergency room after the primary measures had been done, only 50.9% of medical interns correctly answered with “refer the patient to an otolaryngologist to take further care.” Using two-tailed Chi-square test, there were no differences in the percentages of correct answers among the surveyed medical interns according to gender (P > 0.05). With regard to the sources of information about first aid in the management of epistaxis, the top selected source by medical interns was “self-taught” (52%), followed by “medical textbooks” (19%). Conclusion: The surveyed interns had unsatisfactory knowledge about epistaxis first aid. There is a pressing need to establish solid curricular, extracurricular, and institutional measures to increase the intern's awareness of first aid knowledge in the management of epistaxis.

Keywords: Epistaxis, first aid, knowledge, medical students, nose bleed, Saudi Arabia


How to cite this article:
Abu-Zaid A, Alomari M, AlMazmomy AM, Al-Hayani M, Bazi AG, Althagafi H, Almadani HY. Knowledge of first aid management of epistaxis among medical interns attending King Fahad Armed Forces Hospital in Saudi Arabia. Saudi J Health Sci 2020;9:136-40

How to cite this URL:
Abu-Zaid A, Alomari M, AlMazmomy AM, Al-Hayani M, Bazi AG, Althagafi H, Almadani HY. Knowledge of first aid management of epistaxis among medical interns attending King Fahad Armed Forces Hospital in Saudi Arabia. Saudi J Health Sci [serial online] 2020 [cited 2020 Sep 27];9:136-40. Available from: http://www.saudijhealthsci.org/text.asp?2020/9/2/136/292649




  Introduction Top


The American Heart Association and the American Red Cross define first aid as the initial care provided by bystanders to individuals with acute injuries.[1] Such injuries can range from simple complaints to life-threatening emergencies. The core of the initial care comprises medically sound assessments and evidence-based interventions geared toward lessening suffering, promoting recovery, and preserving life until medical health-care services arrive. Overall, the proper exercise of the first aid dramatically reduces morbidity and mortality from injuries at the sites of accidents.[1]

Epistaxis, bleeding from the nose, is one of the most frequent ear, nose, and throat conditions encountered by primary care and emergency physicians.[2],[3] An apt knowledge of first aid in the management of epistaxis can prove critical not only in alleviating simple epistaxis cases but also lifesaving in epistaxis emergencies in the absence of nearby health-care facilities.[1] Despite its crucial importance, unfortunately, little is known about the knowledge of medical students of first aid generally[4] and in the management of epistaxis specifically.[4],[5],[6]

As the frequency of epistaxis is very high and on the rise,[2],[3] it is critically vital to guarantee that tomorrow's frontline health-care providers (i.e., the medical students) are well-trained to manage such epistaxis events. Thus, the aim of this study is to explore the knowledge of first aid management of epistaxis among medical interns.


  Materials and Methods Top


A cross-sectional study was conducted from January 5, 2020, to January 20, 2020, at King Fahad Armed Forces Hospital (KFAFH), Jeddah, Saudi Arabia. The study participants comprised only students in their final year of education (i.e., medical interns) rotating at the various departments of KFAFH. With a population size of 85 medical interns, 5% margin of error, and 95% confidence interval, the sample size was calculated to be 70 participants. The study's protocol was approved by the Institutional Review Board at KFAFH, Jeddah, Saudi Arabia.

The validated questionnaire to explore the interns' knowledge of first aid in the management of epistaxis was adapted from a previously published article.[5] The questionnaire was administered anonymously using an online survey instrument. The questionnaire was piloted on five students to test for face validity and approximate the time it takes to complete the questionnaire. The questionnaire was found to be valid and no further changes were made.

Data were mostly descriptive and reported as numbers and proportions. Two-tailed Chi-square test was used to compare answers between genders. Statistical significance was determined as a P < 0.05. All analyses were performed using the Statistical Package for the Social Sciences (SPSS) software version 22.0.0.0 (SPSS Inc., Chicago, IL, USA).


  Results Top


A total of 57 medical interns responded to the survey, giving a response rate of 81.4% (n = 57/70). [Table 1] shows the demographical data of the surveyed medical interns. The mean age ± standard deviation was 25 ± 1.6 years (range: 23–33). The vast majority of survey respondents were male (78.9%) and single (80.7%).
Table 1: Demographical data of the surveyed medical interns

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[Table 2] shows the perceptions of the surveyed medical interns about two general questions relating to epistaxis. Around 84.2% of medical interns reported that they had experienced themselves at least one episode of epistaxis and/or seen someone with epistaxis (84.2%). Furthermore, 57.9% of the medical interns declared that epistaxis is regarded as one of the emergency situations.
Table 2: Perceptions of the surveyed medical interns about two general questions relating to epistaxis

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[Table 3] shows the surveyed medical interns' knowledge of first aid in the management of epistaxis. A sum of 71.9% of medical interns correctly identified “finger nail trauma” as the most common cause of epistaxis. In addition, while 71.9% of medical interns correctly answered, “sitting with head tilted forward” as the proper management position for a patient with epistaxis, only 52.6% of the medical interns correctly answered, “pinching the lower cartilaginous part of the nose” as the primary measure to stop epistaxis. On the other hand, when medical interns were asked about what to do if the patient continued to bleed from the nose in the emergency room after the primary measures had been done, only 50.9% of medical interns correctly answered with “refer the patient to an otolaryngologist to take further care.” Using two-tailed Chi-square test, there were no differences in the percentages of correct answers among the surveyed medical interns according to gender (P > 0.05, data not shown).
Table 3: Knowledge of the surveyed medical interns about first aid in the management of epistaxis

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[Table 4] shows the surveyed medical interns' responses to when patients with epistaxis should seek emergency care. The most answered option was “persistent nose bleeding for more than 10–20 min with direct nasal compression” (73.7%), whereas the least answered option was “after direct nasal trauma” (33.3%).
Table 4: Responses of the surveyed medical interns to when patients with epistaxis should seek emergency care

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[Figure 1] shows the sources of information about first aid in the management of epistaxis. The two top selected sources by medical interns were “self-taught” (52%) and “medical textbook” (19%).
Figure 1: Sources of knowledge about first aid in the management of epistaxis among the surveyed medical interns

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  Discussion Top


Overall, our study showed that the surveyed medical interns had unsatisfactory knowledge of first aid in the management of epistaxis.

While 84.2% of the surveyed medical interns self-reported experiencing or seen someone with epistaxis (84.2%), around 57.9% of the interns regarded epistaxis as a medical emergency. According to literature, the estimated lifelong incidence of epistaxis in the general population is roughly 60%, and around 6–10% of the cases warrant urgent medical attention.[3] Nearly 90% of all epistaxis cases arise from anterior bleeds from the Kiesselbach's plexus, and they are commonly self-limiting and resolve spontaneously.[7],[8] Despite a number of epistaxes cases can be severe and warrant medical attention and possibly hospital admission (approximately 10%), the bulk proportion of epistaxis cases are often benign (90%) and can be readily well controlled with simple first-aid maneuvers, such as nasal compression and packing.[9]

A sum of 71.9% of the surveyed medical interns correctly identified “finger nail trauma” as the most common cause of epistaxis. This percentage was approximately two-fold higher than the 39.7% reported by Alyahya et al.[5] With regard to the other questions about first aid in the management of epistaxis [Table 3], the findings of our study were not dramatically different from the findings by Alyahya et al.[5]

To the best of our knowledge, and according to a PubMed search from 2000 to 2019 using the keywords “epistaxis” AND “student,” only three studies have endeavored to explore the knowledge of medical students about first aid in the management of epistaxis.[4],[5],[6] Joseph et al.[4] surveyed 152 medical students from Manipal University (India) and reported that the percentages of medical students with good (score: 147–207), moderate (score: 67–146), and poor (score: 7–66) first aid knowledge in the management of epistaxis were 13.8%, 65.8%, and 20.4%, respectively. Alyahya et al.[5] surveyed 300 medical students from across the Kingdom of Saudi Arabia, and medical interns constituted only 13% (n = 39) of the entire population of respondents. Despite the study concluded that the surveyed medical students possessed adequate first aid knowledge in the management of epistaxis, this conclusion should be interpreted with great caution as the study's sample size of 300 students does not reflect a truly global representation of the entire cohort of medical students in the Kingdom of Saudi Arabia, which is estimated to be more than 23,000 medical students. Halawani et al.[6] surveyed 1000 female college students from Princess Nourah Bint Abdulrahman University (the Kingdom of Saudi Arabia), and the percentage of the surveyed students from the College of Medicine was only 14.6%. There was only one question about first aid in the management of epistaxis, and 84.6% of all surveyed students answered it correctly; however, unfortunately, the exact question asked was not mentioned in the study. Similarly, the findings of this study should be interpreted with caution due to the largely minor representation of medical students in the study as well as the substantial limitation of asking only one question about first aid in the management of epistaxis.

Our findings demonstrated that “self-taught” (52%) was the top source of knowledge about first aid in the management of epistaxis. This figure is so encouraging and reflects the positive attitudes of the surveyed medical interns to learn about the basics of first aid knowledge in the management of epistaxis. Conversely, only 19% and 5% of the surveyed medical interns reported “medical textbook” and “ first aid course”, respectively, as sources of knowledge about first aid in the management of epistaxis. These proportions are disappointing and warrant the need to establish more solid curricular, extracurricular, and institutional measures to increase the awareness of first aid knowledge in the management of epistaxis. Such first aid education is cost-effective and positively decreases unnecessary hospital visits as well as substantially reduces morbidity and mortality from simple and life-threatening incidents pertaining to epistaxis.[1] First aid education can be done through a wide diversity of approaches, such as lectures, online modules, and public health awareness campaigns. From a curricular perspective, medical students are educated, at least at one stage during their education, about how to manage emergency cases in hospital settings whereby all necessities (e.g., drugs, equipment, and resources) are readily accessible.[4] However, medical students may not possess the satisfactory knowledge and skills needed to manage such emergencies at sites whereby health-care facilities are not available. Kurien et al.[10] reported a novel multisensory teaching intervention that effectively instilled the crucial knowledge, skills, and confidence in medical students to manage epistaxis. This novel multisensory teaching intervention comprised an audio presentation, a video presentation, a 5-min theoretical test, a 10-min practical demonstration by an expert, and a 30-min hands-on practical exercise by students.

Our study has limitations that should be acknowledged. Such limitations include the relatively small sample size, the mere inclusion of medical interns, and the mere assessment of “theoretical” knowledge only without the “practical” first aid skills in the management of epistaxis. Future studies will include large-sized sample sizes from various medical schools in the Kingdom of Saudi Arabia and will include assessment of both theoretical knowledge and practical skills pertaining to first aid in the management of epistaxis. Moreover, correlations between the demographics of medical students and their theoretical knowledge/practical skills in the management of epistaxis will be examined in depth.


  Conclusion Top


Overall, our study showed that the surveyed medical interns had unsatisfactory knowledge about first aid in the management of epistaxis, and these findings did not differ according to demographical data of the surveyed medical interns in terms of gender and social status. There is a pressing need to establish more solid curricular, extracurricular, and institutional measures to increase the awareness of first aid knowledge in the management of epistaxis among medical students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Singletary EM, Charlton NP, Epstein JL, Ferguson JD, Jensen JL, MacPherson AI, et al. Part 15:First Aid: 2015 American Heart Association and American Red Cross Guidelines Update forFirst Aid. Circulation 2015;132:S574-89.  Back to cited text no. 1
    
2.
Krulewitz NA, Fix ML. Epistaxis. Emerg Med Clin North Am 2019;37:29-39.  Back to cited text no. 2
    
3.
Womack JP, Kropa J, Jimenez Stabile M. Epistaxis: Outpatient management. Am Fam Physician 2018;98:240-5.  Back to cited text no. 3
    
4.
Joseph N, Kumar G, Babu Y, Nelliyanil M, Bhaskaran U. Knowledge of first aid skills among students of a medical college in Mangalore city of South India. Ann Med Health Sci Res 2014;4:162-6.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Alyahya K, Alsaad S, Alsuliman S, Alsuliman N. Awareness about first aid management of epistaxis among medical students in Kingdom of Saudi Arabia. J Family Med Prim Care 2019;8:914-8.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Halawani LM, Alghamdy SD, Alwazae MM, Alkhayal WA. Knowledge and attitude of Saudi female university students about first aid skills. J Family Community Med 2019;26:103-7.  Back to cited text no. 6
    
7.
Kucik CJ, Clenney T. Management of epistaxis. Am Fam Physician 2005;71:305-11.  Back to cited text no. 7
    
8.
Béquignon E, Teissier N, Gauthier A, Brugel L, De Kermadec H, Coste A, et al. Emergency Department care of childhood epistaxis. Emerg Med J 2017;34:543-8.  Back to cited text no. 8
    
9.
Koh E, Frazzini VI, Kagetsu NJ. Epistaxis: Vascular anatomy, origins, and endovascular treatment. AJR Am J Roentgenol 2000;174:845-51.  Back to cited text no. 9
    
10.
Kurien G, Biron VL, Campbell C, Cote DW, Ansari K. Can a multisensory teaching approach impart the necessary knowledge, skills, and confidence in final year medical students to manage epistaxis? J Otolaryngol Head Neck Surg 2013;42:51.  Back to cited text no. 10
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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