8. Epistaxis (nosebleeds) - workbook Flashcards
what are simple first-aid measures in treating epistaxis (nosebleeds)?
pinching IN FRONT OF not on the bony bridge of nose
applying cold compress
where is the arterial supply to the nasal cavity mainly from?
branches of the maxillary artery (sphenopalatine and greater petrosal)
Ethmoidal branches (from opthalmic, from ICA)
branch of the facial artery
(contributing to nose’s rich blood supply)
how many arteries are there supply the nose?
anastomosis of 5 arteries
where is the anastomosis of the 5 nasal arteries?
on the cartilaginous part of the septum known as Little’s Area
what is Little’s Area also known as? (anastomosis)
Keiselbach’s area / plexus
what is Little’s Area the site of?
origin for most nosebleeds (90%)
aside from Little’s Area, where else do nosebleeds arise from?
sphenopalatine artery
why can bleeds of sphenopalatine artery be particularly problematic?
as blood in sphenopalatine vessel tend to be at high pressure
where is sphenopalatine vessel located?
posteriorly located in the nasal cavity - harder to reach to stop bleeding
how can nosebleeds occur?
spontaneously / very minor trauma to the nose e.g. nose picking, blowing nose
aside from minor causes, how else can nosebleeds arise?
underlying systemic causes e.g. abnormal coagulation and CT disorders
which age-group do nosebleeds commonly occur in?
very young (2-10 years) old (>50-60 years)
what can serious nosebleeds lead to?
potentially risk significant blood loss
rarely even death
what should management of epistaxis be?
initially applying simple compression and leaning forward - should stop most nosebleeds
if applying simple compression and leaning forward doesn’t stop the epistaxis, then what should be done?
cauterise a visible bleeding point using silver nitrate
what should be done if bleeding is significant or the bleeding point cannot be identified?
cautery may prove difficult
anterior packing using nasal tampons can be used
what is cauterise?
burn the skin or flesh of (a wound) with a heated instrument or caustic substance in order to stop bleeding or to prevent infection
how do nasal tampons (anterior packing) work?
they expand within the nasal cavity and tamponade the area of bleeding
if bleeding still continues despite anterior packing, then what should be done?
posterior packing
surgical intervention e.g. embolisation (last resort) - ligation of blood vessels
what should be monitored in severe epistaxis?
the patient’s ABC
blood tests taken to check their Hb levels and clotting
any underlying systemic causes for bleeding should also be sought and treated
what can be an underlying systemic causes for bleeding?
coagulopathies
what is coagulopathies?
the blood’s ability to coagulate (form clots) is impaired (bleeding disorder)
