[ENT] Epistaxis Flashcards
where do most epistaxes occur?
anteriorly in Little’s area (90-95%)
what are the two age peaks of incidence?
children (2-15)
adults (>45)
what are the risk factors for epistaxis?
- alcohol intake/excess
- anticoagulant/antiplatelet use
- bleeding/clotting disorders
- topic drugs (decongestants, cocaine)
- nasal polyps
- chronic sinusitis
what are the signs of a posterior bleed?
- profuse bleeding
- bleeding from both nostrils
- no bleeding points can be found
- suspected anterior bleed has not resolved with rx
what are the localised causes of epistaxis?
- trauma (nose picking, FBs)
- inflammation (sinusitis, recent URTI)
- vascular (Telangiectasia)
- tumours (angiofibroma, SCC)
- dry membranes (air conditioning, nasal cannulae)
- post-op bleeding
- topical drugs (decongestants, cocaine)
what are the generalised causes of epistaxis?
- atherosclerosis
- raised venous pressure (e.g. mitral stenosis)
- haematological disorders (von Willebrand disease, haemophilia, leukaemia)
- systemic drugs (anticoagulants, antiplatelets)
- alcohol excess
NOT arterial HTN (no link!)
what is nasopharyngeal carcinoma?
- common cancer of the nasopharynx
- a form of SCC
what does nasopharygeal carcinoma present with?
a progressive disease presenting with nasal obstruction and neuropathies of CNs III, IV, V and VI
what are the risk factors for nasopharyngeal carcinoma?
- Chinese
- male
- EBV exposure
- smoked fish consumption (nitrosamines)
- smoking
how is nasopharyngeal carcinoma managed?
- radiotherapy
- systemic chemotherapy
what can be done for residual disease in nasopharyngeal carcinoma?
nasopharyngectomy
what can be done for metastatic disease in nasopharyngeal carcinoma?
neck dissection
how do you manage epistaxis?
- identify and control any risk factors e.g. anticoagulants:
- nasal pressure 15 mins
- tranexamic acid - assess location of bleeding
what can be done for anterior bleeding?
silver nitrate cautery
pt gets silver nitrate cautery for anterior bleeding and bleeding resolves. what next?
discharge with topical Naseptin
pt gets silver nitrate cautery for anterior bleeding and bleeding does not resolve. what next?
‘rapid rhino’ unilateral anterior packing
pt gets ‘rapid rhino’ unilateral anterior packing and bleeding resolved. what next?
discharge with packing and for ENT review the following day
pt gets ‘rapid rhino’ unilateral anterior packing but bleeding persists. what next?
admit to hospital:
- bilateral posterior packing
- abx
- surgery if indicated
- replace blood and reverse coagulation if needed
what is the mx for posterior bleeding?
admit to hospital:
- bilateral posterior packing
- abx
- surgery if indicated
- replace blood and reverse coagulation if needed
Chinese ethnicity, facial pain, double vision and persistent lymphadenopathy. dx?
nasopharyngeal carcinoma
young child with recurrent epistaxis and purpuric lesions on the fingertips and tongue. dx?
hereditary haemorrhagic telangiectasia
evolving sunburn-like erythema and confusion >48 hours nasal packing. dx?
toxic shock syndrome
what is the 1st line ix for epistaxis?
nasal speculum examination
how often should nasal packing be changed and why?
every 48 hours to reduced risk of toxic shock syndrome
