1: Epistaxis Flashcards
What is epistaxis
Bleeding from the nose
Why is epistaxis a medical emergency
- Aspiration risk
- Hypovolaemic shock
What are the two types of node bleeds
Anterior
Posterior
What type of nose bleed are 90% of bleeds
Anterior
What is the site of anterior nose bleeds
Little’s area - where Kiesselbachs plexus is located
What 4 arteries anastomose at kiesselbach’s plexus
- Anterior ethmoidal
- Posterior ethmoidal
- Sphenopalatine
- Facial (Greater palatine, Superior labial artery)
What % of nose-bleeds are posterior bleeds
10
In which individuals are posterior bleeds more common
Elderly
What is the problem with posterior bleeds
Higher risk of aspiration
What are the causes of nose-bleeds
- Trauma (Picking, Foreign body)
- HTN
- Anticoagulants
- Clotting disorders
- Rhinosinusitus
- Malignancy
- Cocaine
In what position should patients with nose bleeds be sat and why
Upright, Forwards and With their mouth open = reduces risk of aspiration and decreases blood flow to nasopharynx
What is first-line in patients haemodynamically stable with a nose bleed
Pinch cartilaginous portion nose for 15-minutes
Or, nasal peg 20 minutes
If nose-bleed recovered by first-aid measures what are people given
Nasoseptin cream
What is nasoseptin
Contains Chlorhexidine and Neomycin
Why is nasoseptin given
Reduce crusting and vestibulitis
What are 3 contraindications of naseptin
- Peanut allergy
- Soy allergy
- Neomycin allergy
If solved by first-aid measures under what 2 circumstances will someone be followed up
- Co-morbidities (Malignant HTN)
- Under 2-years
Why are children under-2 followed up following a nose bleed
Higher risk underlying leukaemia or haemophilia
What is second-line if pinching nose unsuccessful
Ice
Where should ice be applied
Back of the neck or nasal bridge
What is the aim of ice
Vasoconstriction
What investigations are ordered for nose bleeds
FBC
Coagulation studies
G+S
Cross match
What is used to inspect the nasal septum
Thudichum
If there is too much blood to visualise the nasal cavity what is added
Adrenaline-soaked gauze
If unable to find bleeding point what should be inspected
Oropharynx
If anterior nose bleed what is next step in management
Cauterise with silver nitrate
If posterior nose bleed what is next step in management
Nasal Packing
What is used to pack nose anteriorly
Nasal tampon.
Pack unilaterally, if bleeding continues pack bilaterally
How long is a nasal tampon kept in
24h
What is used to pack nose posteriorly
Bismuth iodoform and paraffin paste gauze (BIPPG)
Pack unilaterally. If bleeding continues, pack contra laterally.
When is surgery indicated
Bleeding continues
What are the two types of surgery
Ligation or embolisation
What one artery should not be embolised and why
Anterior ethmoid artery - branch of ophthalmic artery which is a branch of ICA
What is a mnemonic to remember arteries of kesselbachs plexus
GASPS
What are the arteries of kesselbachs plexus
Greater palatine
Anterior ethmoidal
Septal branch of grater palatine
Sphenopalatine
Posterior ethmoidal
