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JAGDEEP DOULLA PGY-2
FAMILY MEDICINE PRIMROSE FAMILY HEALTH CENTER
Epistaxis
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Outline
EpidemiologyAnatomy Case Diagnosis Anterior Bleed Management Posterior Bleed Management References
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History
60% of individuals worldwide will get a nose bleed in their lifetime
Average age of patients presenting to FD or ED Children <10 years old Adults > 35 years old
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Anterior Circulation
External carotid facial artery and sphenopalatine artery
Internal carotid anterior and posterior ethmoidal arteries
90% bleeds at Kiesselbach’s Area Nasal Septum
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Posterior Circulation
External Carotid sphenopalatine branch of the internal maxillary artery
Common in older patients >64 years old
Lateral Nasal Wall
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Common is Common
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Case
65 yo male presents with right sided epistaxis Hx of HTN
Medications Atenolol ASA
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Patient Evaluation
Ensure patent airwayHemodynamic stability
History Duration Frequency Severity Inciting factors Family hx of bleeding problems
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Diagnosis
Common Causes Chronic Sinusitis Epistaxis Digitorum Foreign Bodies Neoplasms & Polyps Irritants Medications – topics
steroids Rhinitis Septal deviation Septal perforation Trauma Vascular malformations or
telangiectasia's
Systemic Causes Hemophilia Hypertension Leukemia Liver disease –
cirrhosis Medications
ASA Anticoagulants NSAID’s
Platelet dysfunction Thrombocytopenia
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Approach to Anterior Bleed
Lidocaine with phenylephrine spray to help examine and slow down some of the bleeding If available cocaine
can be used Septal Pressure for 5-
20 min
Anterior Packing Cotton swabs Ribbon gauze
impregnated with petroleum jelly
Nonadherent gauze
Chemical Cautery Silver nitrate
Electric Cautery
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Anterior Packing
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Approach to Posterior Bleed
Posterior Packing Usually required in
older individuals taking blood thinners
If you can visualize the bleed
Chemical Cautery Silver nitrate
Electric Cautery
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Posterior Packing
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References
Kucik, CJ., Clenny, T. 2005. Management of Eppistaxis. AAFP (71) pg 305-311.
Schlosser, RJ. 2009. Epistaxis. New England Journal of Medicine 360(8) pg 784-789.