Epistaxis Flashcards
List 4 causes of epistaxis.
Local trauma
- Nose picking
- Facial trauma
- Foreign bodies
- Nasal or sinus infections
- Nasal septum deviation
Environmental
- Dry/cold conditions
- Prolonged inhalation of dry air (oxygen)
Iatrogenic
- NG tube insertion
- Nasotracheal intubation
Medicinal
- Topical corticosteroids and antihistamines
- Solvent inhalation
- Snorting cocaine
- Anticoagulants
Coagulopathic
- Inherited coagulopathies
- Splenomegaly
- Platelet disorders
- Chronic alcohol abuse
- AIDS
Vascular abnormalities
- AV malformation
- Hereditary haemorrhagic telangiectasia
- Endometriosis
What is the first aid management of epistaxis?
- Pressure applied to anterior aspect of the nose (soft part) for 15-20mins at least
- Sit forward to avoid blood dripping into stomach - works in 90% of cases.
- Breathe with mouth open and spit out any blood.
How long should rapid rhinos be in place?
24hrs- usually may go home unless comorbidities
How is epistaxis categorised?
Anterior or posterior bleeds
How does anterior epistaxis present clinically and what is the cause?
Usually has a visible source
Source mostly due to insult of capillaries that form Kiesselbach’s plexus
How does posterior epistaxis present clinically?
What is the risk associated with them?
More profuse and originate from deeper structures
More common in older patients
Risk: higher risk of aspiration and airway compromise
If epistaxis due to chronic cocaine use suspected, what woudl the nasal septum look like?
Abraded or atrophied septum - inhaled cocaine is a powerful vasoconstrictor and will eventually result in obliteration of the septum
Which autoimmune disease can present with epistaxis?
GPA
What is the management of epistaxis if first aid measures do not suffice?
- Topical antiseptic e.g. Naseptin - chlorhexidine and neomycin, OR Mupirocin
If bleeding does not stop after another 10-15mins:
* Cautery with silver nitrate (only one side of septum)
OR if bleeding not visible/cautery not tolerated:
* Rapid Rhino/packing - a type of nasal tampon with outside carboxycellulose that promotes platelet aggregation and an inflatable balloon for compression
Admit to hospital if comorbidities e.g. CAD, severe HTN, <2yo
What is the management if epistaxis has failed all emergency options?
Sphenopalatine ligation in theatre
How is nasal cautery carried out for epistaxis?
- Ask pt to blow nose to remove any clots
- Use topical anaesthetic spray e.g. co-phenylcaine and wait 3-4mins
- Identify bleeding point and apply silver nitrate stick for 3-10seconds until grey-white
- Only cauterise one side of septum to avoid perforation
- Dab area clean with cotton and apply Naseptin/Mupirocin
How is packing carried out for epistaxis?
- Anaesthetise with topical anaesthetic e.g. co-phenylcaine and wait 3-4mins
- Pack the nose while the patients sits with head forward
- Once inserted, examine patient’s mouth and throat for any continuing bleeding, and consider packing other nostril to increase pressure on septum and vessels
- Admit to hospital for observation
