1: Epistaxis

Question 1

What is epistaxis

Answer 1

Bleeding from the nose

Question 2

Why is epistaxis a medical emergency

Answer 2

• Aspiration risk

- Hypovolaemic shock

Question 3

What are the two types of node bleeds

Answer 3

Anterior

Posterior

Question 4

What type of nose bleed are 90% of bleeds

Answer 4

Anterior

Question 5

What is the site of anterior nose bleeds

Answer 5

Little’s area - where Kiesselbachs plexus is located

Question 6

What 4 arteries anastomose at kiesselbach’s plexus

Answer 6

1. Anterior ethmoidal
2. Posterior ethmoidal
3. Sphenopalatine
4. Facial (Greater palatine, Superior labial artery)

Question 7

What % of nose-bleeds are posterior bleeds

Answer 7

10

Question 8

In which individuals are posterior bleeds more common

Answer 8

Elderly

Question 9

What is the problem with posterior bleeds

Answer 9

Higher risk of aspiration

Question 10

What are the causes of nose-bleeds

Answer 10

• Trauma (Picking, Foreign body)
• HTN
• Anticoagulants
• Clotting disorders
• Rhinosinusitus
• Malignancy
• Cocaine

Question 11

In what position should patients with nose bleeds be sat and why

Answer 11

Upright, Forwards and With their mouth open = reduces risk of aspiration and decreases blood flow to nasopharynx

Question 12

What is first-line in patients haemodynamically stable with a nose bleed

Answer 12

Pinch cartilaginous portion nose for 15-minutes

Or, nasal peg 20 minutes

Question 13

If nose-bleed recovered by first-aid measures what are people given

Answer 13

Nasoseptin cream

Question 14

What is nasoseptin

Answer 14

Contains Chlorhexidine and Neomycin

Question 15

Why is nasoseptin given

Answer 15

Reduce crusting and vestibulitis

Question 16

What are 3 contraindications of naseptin

Answer 16

1. Peanut allergy
2. Soy allergy
3. Neomycin allergy

Question 17

If solved by first-aid measures under what 2 circumstances will someone be followed up

Answer 17

• Co-morbidities (Malignant HTN)

- Under 2-years

Question 18

Why are children under-2 followed up following a nose bleed

Answer 18

Higher risk underlying leukaemia or haemophilia

Question 19

What is second-line if pinching nose unsuccessful

Answer 19

Ice

Question 20

Where should ice be applied

Answer 20

Back of the neck or nasal bridge

Question 21

What is the aim of ice

Answer 21

Vasoconstriction

Question 22

What investigations are ordered for nose bleeds

Answer 22

FBC
Coagulation studies
G+S
Cross match

Question 23

What is used to inspect the nasal septum

Answer 23

Thudichum

Question 24

If there is too much blood to visualise the nasal cavity what is added

Answer 24

Adrenaline-soaked gauze

Question 25

If unable to find bleeding point what should be inspected

Answer 25

Oropharynx

Question 26

If anterior nose bleed what is next step in management

Answer 26

Cauterise with silver nitrate

Question 27

If posterior nose bleed what is next step in management

Answer 27

Nasal Packing

Question 28

What is used to pack nose anteriorly

Answer 28

Nasal tampon.

Pack unilaterally, if bleeding continues pack bilaterally

Question 29

How long is a nasal tampon kept in

Answer 29

24h

Question 30

What is used to pack nose posteriorly

Answer 30

Bismuth iodoform and paraffin paste gauze (BIPPG)

Pack unilaterally. If bleeding continues, pack contra laterally.

Question 31

When is surgery indicated

Answer 31

Bleeding continues

Question 32

What are the two types of surgery

Answer 32

Ligation or embolisation

Question 33

What one artery should not be embolised and why

Answer 33

Anterior ethmoid artery - branch of ophthalmic artery which is a branch of ICA

Question 34

What is a mnemonic to remember arteries of kesselbachs plexus

Answer 34

GASPS

Question 35

What are the arteries of kesselbachs plexus

Answer 35

Greater palatine

Anterior ethmoidal

Septal branch of grater palatine

Sphenopalatine

Posterior ethmoidal