Epistaxis

Question 1

What % of epistaxis is ANTERIOR?

Answer 1

90% anterior
10% posterior

Question 2

Which vessel is responsible for POSTERIOR epistaxis?

Answer 2

Sphenopalatine

Question 3

Features of POSTERIOR epistaxis:

Answer 3

Both nares bleeding
Neither nare bleeding
+++ being swallowed
Failure of good anterior packing

Question 4

Management steps in epistaxis:

Answer 4

1- Apply pressure
2- Vasoconstrictors
Suck ice
Blow or suction clot out first:
–> Cophenylcaine spray
–> TXA gauze
–> Adrenaline 1:1000 gauze
Then pressure over top
3- Silver nitrate cautery
4- Anterior packing
–> Gauze ribbon lubricated with antibiotic ointment
5- Anterior tamponade
–> Rapid Rhino
–> Merocel tampon

If failing, it’s a POSTERIOR bleed:
6- Posterior tamponade
–> Posterior balloon device
–> Foley 10-14F
7- Posterior packing (rare)

Massive: sit upright, suction, tube

Question 5

Method: Anterior Packing

Answer 5

Ligocaine spray ++
Petroleum gauze
Insert horizontal along floor with forceps
Build accordion-style

Question 6

Method: Posterior packing

Answer 6

10 - 14F Foley
Feed + pull from mouth
Suture gauze pack to end
Pull back in

Question 7

Method: Rapid Rhino

Answer 7

Question 8

After care for patient with nasal packing/ tamponade:

Answer 8

ADMIT ALL POSTERIOR PACKING
- Hypoxia, asphyxiation, pressure necrosis, rebleed

Anterior packing allowed home
- Follow up 2 -3 days with ENT.

Prophylactic antis eg. Augmentin
- (widely recommended, little evidence)
- Prevent toxic shock, sinusitis.

Pack in for max 72hrs

Question 9

Complications of bacterial sinusitis:

Answer 9

Osteomyelitis
–> ‘Potts’ = frontal OM + subperiosteal abscess
Orbital cellulitis
Cavernous sinus thrombosis
Meningoencephalitis/ brain abscess