5 - ENT - Rhinology - Epistaxis

Question 1

2 types - where from?

Answer 1

anterior - from little area - anterior septum

posterior - lateral nasal wall - inferior meatus

Question 2

causes of epistaxis

Answer 2

trauma
anticoagulation
HTN, coagulation disorder, vaculitis
infective/allergic rhinosinusitis
neoplasm
FB

Question 3

mgmt - FIRST remember..

Answer 3

gown, goggles, gloves

and ABC - protect airway if endangered, fluids if lost a lot of blood

Question 4

mgmt - determine history - salient points?

Answer 4

on warfarin
recent infection
mechanism of trauma

Question 5

step 1 of mgmt

Answer 5

apply pressure to end of nose while sitting forwards and spitting any blood out for 15 mins

Question 6

step 2 of mgmt

Answer 6

lidocaine and adrenaline eg spray on cotton wool

Question 7

step 3 of mgmt

Answer 7

silver nitrate cautery - remove clots first - DO ONE SIDE ONLY - perforation risk - can do other side after a week

Question 8

step 4 of mgmt

Answer 8

anterior nasal pack - remove after 24h if OK - if bleeding continues insert postnasal pack

Question 9

what to do with pts with packs

Answer 9

admit them
for monitoring

maybe AB’s to prevent infection around pack