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    01 Epistaxis

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    wissam salim
    The document discusses epistaxis (nosebleeds), including its definition, epidemiology, vascular anatomy, classification, etiology, and management. It notes that epistaxis is the most common otolaryngologic emergency and affects up to 60% of people in their lifetime. Management depends on determining the location and cause of bleeding and may involve first aid techniques, cauterization, nasal packing, or more advanced procedures.

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    01 Epistaxis

    Uploaded by

    wissam salim
    16 views23 pages
    The document discusses epistaxis (nosebleeds), including its definition, epidemiology, vascular anatomy, classification, etiology, and management. It notes that epistaxis is the most common otolaryngologic emergency and affects up to 60% of people in their lifetime. Management depends on determining the location and cause of bleeding and may involve first aid techniques, cauterization, nasal packing, or more advanced procedures.

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    The document discusses epistaxis (nosebleeds), including its definition, epidemiology, vascular anatomy, classification, etiology, and management. It notes that epistaxis is the most common otolaryngologic emergency and affects up to 60% of people in their lifetime. Management depends on determining the location and cause of bleeding and may involve first aid techniques, cauterization, nasal packing, or more advanced procedures.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    16 views23 pages

    01 Epistaxis

    Uploaded by

    wissam salim
    The document discusses epistaxis (nosebleeds), including its definition, epidemiology, vascular anatomy, classification, etiology, and management. It notes that epistaxis is the most common otolaryngologic emergency and affects up to 60% of people in their lifetime. Management depends on determining the location and cause of bleeding and may involve first aid techniques, cauterization, nasal packing, or more advanced procedures.

    Copyright:

    © All Rights Reserved
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    of 23

    Epistaxis

    Prof.dr Rahi
    Alyasiri
    BACKGROUND
    Epistaxis is defined as bleeding from
    the nose.

    derived from the Greek term


    epistazein,
    EPIDEMIOLOGY
    -is the most common otolaryngologic
    emergency
    -affects up to 60% of the population in
    their lifetime
    -6% require medical attention.
    -has a bimodal distribution.
    -The first peak occurs in the pediatric
    population in children under the age of
    10,
    -The second peak is in the adult
    population over the age of 35–50.
    EPIDEMIOLOGY
    the number of cases of epistaxis is
    highest during the winter months

    -the increased number of respiratory


    infections in the colder months causes
    direct damage to the nasal mucosa.
    -The lower ambient humidity and dryness
    associated with indoor heating systems.
    VASCULAR ANATOMY
    LITTLE’S AREA
    It is situated in the anterior inferior part of nasal
    septum,
    Four arteries
    —anterior ethmoidal,
    ---septal branch of superior labial,
    --- septal branch of sphenopalatine
    ----the greater palatine,
    anastomose here to form a vascular plexus
    called “Kiesselbach’s plexus.” This area is
    exposed to the drying effect of inspiratory
    current and to finger nail trauma, and is the
    usual site for epistaxis in children and young
    adults.
    Retrocolumellar vein.
    This vein runs vertically downwards
    just behind the columella, crosses the
    floor of nose and joins venous plexus
    on the lateral nasal wall. This is a
    common site of venous bleeding in
    young people.
    WOODRUFF’S PLEXUS
    It is a plexus of veins situated inferior
    to posterior end of inferior turbinate. It
    is a site of posterior epistaxis in
    elderly people .
    CLASSIFICATION OF EPISTAXIS
    ETIOLOGY
    MANAGEMENT
    MANAGEMENT
    When managing an epistaxis patient,
    determining the
    etiology and identifying the location of the
    bleeding vessel is the priority.
    INITIAL MANAGEMENT
    If an episode of epistaxis is severe
    ATLS protocol goes into effect as in any case of an
    unstable patient.
    If needed,
    --the patient’s airway should be secured
    . Two large bore intravenous lines should be obtained
    for fluid resuscitation and the possibility of blood
    transfusion if the patient
    is hemodynamically unstable from massive blood
    loss.
    Vitals should be monitored continuously.
    MANAGEMENT
    In any case of epistaxis, it is important to know:
    A-History
    1. Mode of onset. Spontaneous or finger nail
    trauma.
    2. Duration and frequency of bleeding.
    3. Amount of blood loss.
    4. Side of nose from where bleeding is occurring.
    5. Whether bleeding is of anterior or posterior
    type.
    6. Any known bleeding tendency in the patient or
    family.
    7. History of known medical ailment (hypertension,
    leukaemia,mitral valve disease, cirrhosis and
    nephritis).
    8. History of drug intake (analgesics,
    anticoagulants, etc.).
    B- Examination :
    --- general examination
    ---anterior rhinoscopy
    ---posterior rhinoscopy
    --- endoscopic examination
    C- Investigations:
    Blood group and Rh
    Clotting and bleeding profile
    Imaging studies
    A-FIRST AID
    Most of the time, bleeding
    occurs from the Little’s area
    and
    can be easily controlled by
    pinching the nose with thumb
    and index finger for about 5
    min. This compresses the
    vessels
    of the Little’s area. In Trotter’s
    method patient is made to
    sit, leaning a little forward over
    a basin to spit any blood and
    breathe quietly from the mouth.
    Cold compresses should be
    applied to the nose to cause
    reflex vasoconstriction.
    B-CAUTERIZATION
    This is useful in anterior epistaxis when bleeding
    point has been located. The area is first topically
    anaesthetized and the bleeding point cauterized
    with a bead of silver nitrate or coagulated with
    electrocautery.
    Epistaxis management: equipment and
    medicines
    1. Nasal cream
    (Naseptin)
    2. Topical anaesthetic +
    decongestant
    (Cophenylcaine).
    3. Head light.
    4. Silver nitrate cautery
    sticks.
    5. Adrenaline vial +
    patties for application.
    6. Nasal speculum.
    7. Blood bottles: full
    blood count, coagulation,
    group and save.
    8. Rigid nasal endoscope.
    9. Tilley’s dressing
    forceps.
    10. Large bore cannula.
    11. Suction.
    C- ANTERIOR NASAL PACKING
    If bleeding is profuse and/or the site of bleeding
    is difficult to localize, anterior packing should be
    done. For this, use a ribbon gauze soaked with
    liquid paraffin. About 1 m gauze (2.5 cm wide in
    adults and 12 mm in children) is required for
    each nasal cavity.
    First.. Pack can be removed after 24 h, if bleeding
    has stopped. Sometimes, it has to be kept for 2–3
    days; in that case, systemic antibiotics should be
    given to prevent sinus infection and toxic shock
    syndrome.
    D-POSTERIOR NASAL PACKING
    for posterior epistaxis
    E-ENDOSCOPIC CAUTERIZATION

    F-ELEVATION OF MUCOPERICHONDRIAL
    FLAP AND SUBMUCOUS RESECTION
    (SMR)OPERATION
    G-LIGATION OF VESSELS
    1. External carotid.
    2. Maxillary artery.
    3. Ethmoidal arteries.

    H-TRANSNASAL ENDOSCOPIC
    SPHENOPALATINE ARTERY LIGATION
    (TESPAL)
    I-EMBOLIZATION

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