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EPISTAXSIS

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WHY EPISTAXSIS …?

5-10% of the population experience an episode of epistaxis each year.

10% of those will see a physician.

1% of those seeking medical care will need a E.N.T. Specialist.

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Why bleeding from the nose?

Vascular organ to provide requried heating/humidification

Vasculature runs just under mucosa (not squamous)

Arterial to venous anastamoses ICA and ECA blood flow

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Kesselbach’s Plexus/Little’s Area:

-Anterior Ethmoid (Opth)

-Superior Labial A (Facial)

-Sphenopalatine A (IMAX)

-Greater Palatine (IMAX)

Woodruff’s Plexus:-Pharyngeal & Post. Nasal AA of Sphenopalatine A (IMAX)

classification

Anterior epistaxis

more common

Mostly from little’s area or ant.part of lateral wall

Mostly occur in children or young adults

Mostly trauma

Usually mild can be

controlled by local pressure

Or anterior pack

Posterior epistaxis

Less common

Mostly from posterosuperior part of nasal cavity

After 40 years of age

Spontaneous: often due to hypertension

Bleeding is severe requires hospitalization

Posterior nasal pack often required

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IDIOPATHICIDIOPATHIC

LOCAL

GENERALGENERAL

The commonest causeThe commonest cause

• TraumaticTraumatic

• InflammatoryInflammatory

• NeoplasticNeoplastic

1.1. Infective rhinitisInfective rhinitis

2.2. Atrophic rhinitisAtrophic rhinitis

3.3. Sinusitis Sinusitis 1.1. Nose Nose

2.2. NasopharynxNasopharynx

3.3. sinussinus

1.1. Nose pickingNose picking2.2. F.B.F.B.3.3. Nasal surgeryNasal surgery4.4. fracturesfractures

1.1. Systemic hypertensionSystemic hypertension

2.2. Venous engorgementVenous engorgement

3.3. Hematological and vascularHematological and vascular

4.4. drugs drugs

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PATIENT HISTORY

PHYSICAL EXAMINATION

LABORATORY TESTING

1. BLEEDING DISODERS

2. HYPERTENSION

3. ATHEROSCLEROSIS

4. TRAUMA

5. DRUG INTAKE

6. RECURRENT BLEEDING

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PATIENT HISTORY

PHYSICAL EXAMINATION

LABORATORY TESTING

G/E: Monitor vital signs

Chest / Heart / Abdomen

L/E: Nasal ex.

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PATIENT HISTORY

PHYSICAL EXAMINATION

LABORATORY TESTING

CBC

BT /CT

PT/PTT

RENAL FUNCTION

LIVER FUNCTION

CLOTTING FS

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Trotte

r's M

ethod

ImmediatImmediatee

Press

ure on

nos

trils

Ice o

r col

d pa

ck

Packing of t

he nose

Sedat

ives

Packing of p

ostnasa

l space

System

ic an

tibiot

ics

CorrectCorrect the underlyingthe underlying

causecause

SHOCKSHOCK

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Pressure on nostrils

Ice or cold pack

Systemic antibiotics

Trotter's Method

Packing of the nose

Sedatives

Packing of postnasal space

ImmediatImmediatee

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EMBOLI

Arterial ligation

Packing

Cautery

Curative Curative

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Pick a Pack, any pack

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Pick a pack to pack with

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suction

good lightanesthetic

silver nitrate

merocels

gelfoam

bacitracin

endoscopes

suction bovie/bipolar

Afrin

T.C.A.

surgicel

epistat

bayonet forceptsvaseline gauze

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