ENT- Epistaxis Flashcards

1
Q

What percent of epistaxis cases are due to an anterior bleed vs a posterior bleed?

A

Anterior bleed (from Kiesselbach’s plexus)- 95%

Posterior bleed- 5%

***DONT WANT TO MISS POSTERIOR BLEED- CAN BE FATAL****

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2
Q

Etiology of epistaxis

A
  1. Nasal trauma (ex: picking nose)
  2. Mucosal dryness/irritation
  3. Mucosal hyperemia
  4. Foreign body / neoplasm
  5. Intranasal drug use
  6. Alcohol
  7. Anticoagulation therapy
  8. Blood disorders
  9. Atherosclerotic disease
  10. Hereditary hemorrhagic telangiectasia
  11. ?hypertension

*Nasal glucocorticoids can also caus epistaxis

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3
Q

What history questions should be asked for epistaxis?

A

–Explore possible causes

–Timing, frequency, severity

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4
Q

What is important to note on examination for epistaxis?

A

–Vitals, mental status, airway

–Nose: may need to pretreat with anesthetic or vasoconstrictor; try to identify source

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5
Q

What labs might need to be drawn on a patient presenting with epistaxis?

A

–PT/INR – only anticoagulated patients

–Hematocrit, type and crossmatch

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6
Q

What are possible treatments for epistaxis?

A
  1. Conservative measures
  2. Cautery
  3. Nasal packing
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7
Q

Epistaxis treatment- conservative measures

A
  • Occlusion, continuous x 10-15 minutes
  • Lean forward to prevent swallowing blood
  • Cold compress to bridge of nose
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8
Q

Epistaxis treatment options- cautery

A

Can use silver nitrate or electrical

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9
Q

What are different methods of nasal packing for treatment of epistaxis?

A
  • Nasal tampon (concern for TSS)
  • Gauze packing
  • Nasal balloon catheter
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10
Q

Overview of epistaxis management

A
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11
Q

What to do with a patient who has epistaxis and has persistent bleeding

A
  1. Contralateral packing
  2. ENT consultation
  3. Posterior bleed- emergency, likely admission
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12
Q

Epistaxis- after bleeding is controlled

A

–Avoid straining or vigorous exercise

–Apply nasal saline to packing

–Avoid hot or spicy food, tobacco (vasodilation)

–Avoid nasal trauma

–Lubrication (petroleum jelly or bacitracin ointment)

–Increase home humidity

–+/- antibiotics for TSS prophylaxis (if doing nasal tampon)

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