Epistaxis(nosebleed)Epistaxis(nosebleed)

EpistaxisEpistaxis

Synonyms:Synonyms: nasal hemorrhage, nose bleed, bosebleed, bloody nasal hemorrhage, nose bleed, bosebleed, bloody nose.nose.

Background:Background: nosebleed is defined as acute hemorrhage from nosebleed is defined as acute hemorrhage from the nostril, nasal cavity, nasopharynx. In the majority of the the nostril, nasal cavity, nasopharynx. In the majority of the cases, bleeding is in small quantities and self-limited, cases, bleeding is in small quantities and self-limited, sometimes it can be very intense and life-threateningsometimes it can be very intense and life-threatening..

Incidence:Incidence: with peak in those aged 2-10 years and 50-80 years. No sex predilection.

Climates factor:Climates factor: nose bleed most common occurs nose bleed most common occurs

during colder month and in dry colder climatesduring colder month and in dry colder climates

EpistaxisEpistaxis

Pathophysiology:● Primary bleeding site: anterior is common. Posterior is rare● Little’s area is most commonly bleeding site

(Kieselbach’ plexus)● Posterior bleeding usually originate below the posterior half of the inferior turbinate or roof of the nasal cavity.

EpistaxisEpistaxis

Cause:Cause:Local causesLocal causes

◆ Trauma: fracture of nasal boneTrauma: fracture of nasal bone ◆ ◆ Infection: viral rhinitis, acute rhinitis.Infection: viral rhinitis, acute rhinitis. ◆ ◆ Foreign bodies:Foreign bodies:

◆◆ Deviation of the nasal septumDeviation of the nasal septum ◆ ◆ Atmospheric change, dry climatesAtmospheric change, dry climates ◆ ◆ Tumors in nasal cavity and sinusesTumors in nasal cavity and sinuses

EpistaxisEpistaxis

General CausesGeneral Causes ◆ hypertension and heart diseaseshypertension and heart diseases

◆ ◆ pregnancypregnancy

◆◆ Acute general infection Acute general infection

◆ ◆ Drugs abuseDrugs abuse

◆ ◆ Diseases of blood systemDiseases of blood system

EpistaxisEpistaxis

Diagnostic step:Diagnostic step:

1.history: 1.history:

2.localize bleeding site2.localize bleeding site

3.determine causes3.determine causes

4.measurement of blood 4.measurement of blood pressurepressure

5.analysis of blood coagulation5.analysis of blood coagulation

6.radiograph or CT image6.radiograph or CT image

EpistaxisEpistaxis

Treatment:Treatment:Digital press:Digital press: 10 minutes 10 minutes

Cautery:Cautery: AgNO AgNO3 3 ,, laser, laser,

microwavemicrowave

Hardener injection:Hardener injection: 40% urea 40% urea

Nasal packing: Nasal packing:

vaseline gauze, vaseline gauze,

balloonballoon

glutinglutin spongesponge

compressed spongecompressed sponge

EpistaxisEpistaxis

Traditional packing:Traditional packing:

Vaseline gauze ribbonVaseline gauze ribbon

for 24~48 hoursfor 24~48 hours

Prevent infection of Prevent infection of sinus with antibioticsinus with antibiotic

EpistaxisEpistaxis

The step of posterior The step of posterior

nasal packingnasal packing

EpistaxisEpistaxis

Vascular ligationVascular ligation this procedure is used for uncontrolled life-this procedure is used for uncontrolled life-

threatening epistaxis threatening epistaxis external carotid artery(ECA) often be ligated external carotid artery(ECA) often be ligated

because most nosebleed site is the area because most nosebleed site is the area supplied with the branch of ECA .supplied with the branch of ECA .

Calming the patientCalming the patientLowering of blood pressureLowering of blood pressureDiscontinuation of anticoagulationDiscontinuation of anticoagulationAdministration of fluid expandersAdministration of fluid expanders

EpistaxisEpistaxis

How to prevent rebleeding after initial bleeding has stopped

Do not pick or blow nose. Do not pick or blow nose. Do not strain or bend down to lift Do not strain or bend down to lift

anything heavy. anything heavy. Keep head higher than the heart. Keep head higher than the heart. Use a humidifier during dry Use a humidifier during dry

winter monthswinter months A saline nasal spray will also A saline nasal spray will also

moisten dry nasal membranesmoisten dry nasal membranes.