epistaxis final
TRANSCRIPT
Epistaxis
ANATOMY
Epistaxis
• Self-limited, but can be life threatening
• 90-95% anterior epistaxis
Etiology
Types of Nosebleeds
• Anterior– Younger population– Little’s area– Mucosal dryness– Precipitated by infection or minor trauma– Less severe– Tend to reccur– Usually controlled with conservative
measures
Types of Nosebleeds
• Posterior– Older population– Hypertention– Significant bleeding in posterior pharynx– Difficult to stop
Philosophy
• Establish the site of bleeding• Stop the bleeding• Treat the cause
First aid
• Pinched the nostril tightly for 10-20 mins
• Sit up right & lean forward
• Do not swallow the blood
• Prepared with – Gown– Mask– Suction– Speculum– Packing
• Evacuate clots• Topical vasoconstrictor and anesthetic• Identify source
Bleeding from Little’s area
• Cautery (Silver nitrate stick)
• Anterior nasal packing for refractory epistaxis
Other Anterior Nasal Packs• Formed
expandable sponges are very effective
• Available in many shapes, sizes and some are impregnated with antibacterial properties
Bleeding from an unidentified site
• Anterior nasal packingOr
• Posterior nasal packing
Posterior packing
Other posterior nasal Packing
Other Treatments for Refractory Epistaxis
• Greater palatine foramen block• Septoplasty• Endoscopic cauterization• Selective embolization by interventional
radiologist• Internal maxillary artery ligation• Transantral sphenopalatine artery ligation• Intraoral ligation of the maxillary artery• Anterior and posterior ethmoid artery ligation• External carotid artery ligation
Complications Epistaxis Management