epistaxis
TRANSCRIPT
EPISTAXIS Bleeding from inside the nose
• Seen in all age groups• Presents as an emergency• Sign of an underlying disease
Kanika GuptaIII Year MBBSKasturba Medical College
Local• Trauma• Infections• Foreign Bodies
• Neoplasms• Atmospheric Changes
• Deviated Nasal Septum
• Adenoiditis
• Juvenile Angiofibroma
• Malignant Tumours
General
• CVS• Disorders of blood and blood vessels
• Liver disease
• Kidney disease
• Drugs• Mediastinal Compression
• Acute general infection
• Vicarious Menstruation
Idiopathic
• The cause of epistaxis is unknown
Classification Anterior Epistaxis More common Mostly from little’s
area or anterior part of lateral wall
Mostly occurs in children or young adults
The cause is mostly Trauma
Bleeding is usually mild and easily controlled
Posterior Epistaxis Less common Mostly from
posterosuperior part of nasal cavity (bleeding point difficult to localize)
Mostly >40 years of age
The cause is mainly due to hypertension or arteriosclerosis
Severe bleeding, hospitalization, postnasal pack
Sites of Epistaxiso Little’s area – site for 90% of the bleeding caseso Above middle turbinate – due to anterior and posterior ethmoidal arterieso Below middle turbinate – due to sphenopalatine arteryo Posterior nasal cavity – blood directly flows into the pharynxo Diffuse – bleeding occurs both from the septum and lateral wall and is usually seen in blood dyscrasiaso Nasopharynx
Mode of onset Spontaneous/Trauma
Duration and Frequency of bleeding
Amount of blood loss
Site of bleedingBleeding tendencies in
familyKnown medical illness
History of drug intake
Patient made to
sit, record blood loss
during vomiiting or spitting
Reassure, mild sedatio
n
Check pulse, BP
and Respirati
on
Give blood
transfusion if
necesary
Antibiotics to
prevent Sinusitis
Intermittent
Oxygen +/-
Treat any underlying local/general cause
FIRST AID
Pinch the nose with thumb and index finger for about 5 minutes (Compresses vessels in little’s area)Trotter’s Method : Patient in sitting position, made to lean over a sink, spit blood and breathe quietly from mouthCold Compresses : Vasoconstriction
ANTERIOR NASAL PACKING
•Clear the nose by suction
•Localise the bleeding site
•Profuse – Anterior nasal packing
LIGATION OF VESSELS
External Carotid•Above the level of
superior thyroid
Maxillary Artery•Uncontrollable
bleeding•Caldwell-Luc
approach
Ethmoidal Arteries•Anterosuperior
bleeding, not controlled by packing
•Lynch Incision
EMBOLIZATION • Done by interventional radiologist• Femoral artery catheterization• Internal Maxillary Artery is embolized with gelfoam, polyvinyl alcohol or coils• Usually a safe procedure with some risks :• Cerebal Thromboembolism• Local haematoma
Ethmoidal arteries cannot be embolized