Date post: | 20-Nov-2014 |
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Health & Medicine |
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MANAGEMENT OF EPISTAXIS
Dr. Vinay S Bhat
OBJECTIVES
At the end of the class audience should be able to
Describe the blood supply lateral and medial wall of nose
Outline the various methods of treatment of Epistaxis
Describe the individual methods briefly List the newer methods in treatment of
epistaxis Perform first aid for Epistaxis outside the
healthcare setting
Why you should know about management of epistaxis ?
Very common Causes significant concern Most epistaxis can be
managed outside the hospital
BLOOD SUPPLY OF NOSE
REMEMBER
ARTERY OF EPISTAXIS
Sphenopalatine artery
FIRST AID
INITIAL STEPS
Assessment of general condition
Resuscitation if required
Initial medical review
Visualizing bleeding point
DEFINITIVE TREATMENT
Decongestant nasal drops
Adrenaline soaked cotton pledget
Chemical cauterization –silver nitrate
ENDOSCOPIC CAUTERIZATION
Using nasal endoscope and bipolar cautery
Not always available in emergency settings
Requires surgical expertise
Expensive instruments required
Excellent results
NASAL PACKING
ANTERIOR POSTERIOR
BALLOON CATHETERS FOR PACKING
ARTERIAL LIGATION
Sphenopalatine artery
Anterior ethmoidal artery
Posterior ethmoidal artery
External carotid artery
ARTERIAL LIGATIONANTERIOR ETHMOID ARTERY LIGATION
SPHENOPALATINE ARTERY LIGATION
EXTERNAL CAROTID ARTERY LIGATION
REMEMBERExternal carotid artery is ligated distal to its first branch i.e. SUPERIOR THYROID ARTERY WHY??
NEWER METHODS IN MANAGEMENT OF EPISTAXIS
Arterial embolization: selective, super selective
Lasers
Coblation
Harmonic technology
MANAGEMENT PROTOCOL
SUMMERY
Commonly seen condition Most of the patients respond to
conservative theapy Follow the management protocol for best
results Endosopic methods are very accurate Arterial ligations are last options in cases
of intractable epistaxis Newer methods have excellent outcome
but expensive
ASSESSEMENT
Method used to control epistaxis outside healthcare settings is
1. Anterior nasal packing2. Nose pinching3. External carotid artery ligation4. Arterial embolization
ASSESSEMENT
Artery of epistaxis is
1. Anterior ethmoidal artery2. External carotid artery3. Sphenopalatine artery4. Internal carotid artery
FURTHER REDING
Scott-browns otolaryngology 7th edition
Cummings otolaryngology and head &neck surgery 3rd edition
QUESTIONS?
THANK YOU