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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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