Epistaxis Flashcards
What are the subtypes of epistaxis? What do they mean?
plit into anterior and posterior bleeds, whereby the former often has a visible source of bleeding and usually occurs due to an insult to the network of capillaries that form Kiesselbach’s plexus. Posterior haemorrhages, on the other hand, tend to be more profuse and originate from deeper structures.
What is epistaxis?
Nosebleed
What are the causes of epistaxis?
most cases of epistaxis tend to be benign and self-limiting. Exacerbation factors include:
nose picking
nose blowing
trauma to the nose
insertion of foreign bodies
bleeding disorders
immune thrombocytopenia
Waldenstrom’s macroglobulinaemia
juvenile angiofibroma
benign tumour that is highly vascularised
seen in adolescent males
cocaine use
the nasal septum may look abraded or atrophied, inquire about drug use. This is because inhaled cocaine
cocaine is a powerful vasoconstrictor and repeated use may result in obliteration of the septum.
hereditary haemorrhagic telangiectasia
granulomatosis with polyangiitis
What is the first aid management for epistaxis if haemodynamically stable?
Asking the patient to sit with their torso forward and their mouth open
avoid lying down unless they feel faint
his decreases blood flow to the nasopharynx and allows the patient to spit out any blood in their mouth
it also reduces the risk of aspirating blood
Pinch the cartilaginous (soft) area of the nose firmly
this should be done for at least 20 minutes
also ask the patient to breathe through their mouth.
What is the management of anterior epistaxis?
First-line treatment of an anterior bleed is chemical or electrical cautery which can be combined with local anaesthetic and topic vasoconstrictors
packing may be used if cautery is not viable or the bleeding point cannot be visualised
What is the management of posterior epistaxis?
The first-line treatment for posterior bleeds is packing. Posterior bleeds can be difficult to detect but should be suspected in patients with persistent bleeding despite bilateral anterior packing.
What are indications for surgery for epistaxis?
Life-threatening bleeding (emergency surgery)
Patient’s bleeding has resolved but is at a high risk of re-bleeding
Follow-up surgery for a patient who is suspected to have a malignancy which could not be visualised in the first operation.
What are complications of epistaxsis?
Hypovolaemic shock
Aspiration
Intranasal adhesions
Mucosal damage from excessive cautery
Infected nasal packing
Where do majority of nosebleeds originate from
anteriorly in the nasal cavity from Kiesselbach’s plexus.
What is the surgical management of epistaxis?
sphenopalatine artery ligation or angiographic embolisation of the sphenopalatine artery.
