management of epistaxis

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2005

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jurnal epistaksis

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  • S0ATIENTINFORMATION!HANDOUTONNOSEBLEEDSWRITTENBYTHEAUTHORSOFTHISARTICLEISPROVIDEDONPAGE

    3EEPAGEFORDEFINITIONSOFSTRENGTHOFRECOMMENDATIONLABELS

    %PISTAXISORNASALBLEEDINGHASBEENREPORTEDTOOCCUR INUPTOPERCENT OF THE GENERAL POPULATION4HECONDITIONHASABIMODALDISTRIBUTIONWITHINCIDENCEPEAKSATAGESYOUNGERTHANYEARSANDOLDER THANYEARS%PISTAXISAPPEARSTOOCCURMOREOFTENINMALESTHANINFEMALES%PISTAXISISCOMMONANDAFFECTEDPERSONS

    USUALLYDONOT SEEKMEDICAL ATTENTIONPARTICULARLYIFTHEBLEEDINGISMINORORSELFLIMITED )N RARE CASES HOWEVER MASSIVE NASALBLEEDINGCANLEADTODEATH

    !NATOMY4HE RICH VASCULAR SUPPLY OF THE NOSE ORIGINATES FROM THE ETHMOID BRANCHES OF THEINTERNAL CAROTID ARTERIES AND THE FACIAL ANDINTERNALMAXILLARYDIVISIONSOF THE EXTERNALCAROTID ARTERIES !LTHOUGH NASAL CIRCULATIONISCOMPLEX&IGUREEPISTAXISUSUALLYIS DESCRIBED AS EITHER ANTERIOR OR POSTERIORBLEEDING4HISSIMPLEDISTINCTIONPROVIDESAUSEFULBASISFORMANAGEMENT-OSTCASESOFEPISTAXISOCCURINTHEANTERIOR PART OF THE NOSE WITH THE BLEEDINGUSUALLY ARISING FROM THE RICH ARTERIAL ANASTOMOSES OF THENASAL SEPTUM +IESSELBACHSPLEXUS 0OSTERIOR EPISTAXIS GENERALLY ARISESFROMTHEPOSTERIORNASALCAVITYVIABRANCHESOF THESPHENOPALATINEARTERIES3UCHBLEEDING USUALLY OCCURS BEHIND THE POSTERIORPORTION OF THE MIDDLE TURBINATE OR AT THEPOSTERIORSUPERIORROOFOFTHENASALCAVITY)NMOSTCASESANTERIORBLEEDING ISCLINICALLYOBVIOUS)NCONTRASTPOSTERIORBLEEDING MAY BE ASYMPTOMATIC OR MAY PRESENTINSIDIOUSLY AS NAUSEA HEMATEMESIS ANE

    &AMILYPHYSICIANS FREQUENTLYENCOUNTERPATIENTSWITHEPISTAXISNASALBLEEDING )NRARECASESTHIS CONDITIONMAY LEAD TOMASSIVEBLEEDING AND EVENDEATH!LTHOUGH EPISTAXIS CANHAVE ANANTERIOR OR POSTERIOR SOURCE ITMOST OFTEN ORIGINATES IN THE ANTERIOR NASAL CAVITY! DIRECTEDHISTORYANDPHYSICALEXAMINATIONGENERALLYDETERMINETHECAUSEOFTHEBLEEDING"OTHLOCALANDSYSTEMICPROCESSESCANPLAYAROLEINEPISTAXIS.ASALBLEEDINGUSUALLYRESPONDSTOFIRSTAIDMEASURESSUCHASCOMPRESSION7HENEPISTAXISDOESNOTRESPONDTOSIMPLEMEASURESTHESOURCEOFTHEBLEEDINGSHOULDBELOCATEDANDTREATEDAPPROPRIATELY4REATMENTSTOBECONSIDEREDINCLUDETOPICALVASOCONSTRICTIONCHEMICALCAUTERYELECTROCAUTERYNASALPACKINGNASALTAMPONORGAUZEIMPREGNATEDWITHPETROLEUMJELLYPOSTERIORGAUZEPACKINGUSEOFABALLOONSYSTEMINCLUDINGAMODIFIED&OLEYCATHETERANDARTERIALLIGATIONOREMBOLIZATION4OPICALORSYSTEMICANTIBIOTICSSHOULDBEUSEDINSELECTEDPATIENTS(OSPITALADMISSIONSHOULDBECONSIDEREDFORPATIENTSWITHSIGNIFICANTCOMORBIDCONDITIONSORCOMPLICATIONSOFBLOODLOSS2EFERRALTOANOTOLARYNGOLOGISTISAPPROPRIATEWHENBLEEDINGISREFRACTORYCOMPLICATIONSAREPRESENTORSPECIALIZEDTREATMENTBALLOONPLACEMENTARTERIALLIGATIONANGIOGRAPHICARTERIALEMBOLIZATIONISREQUIRED!M&AM0HYSICIAN#OPYRIGHT!MERICAN!CADEMYOF&AMILY0HYSICIANS

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  • !MERICAN&AMILY0HYSICIAN WWWAAFPORGAFP 6OLUME.UMBER U*ANUARY

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