Epistaxis Flashcards
Nosebleeds are also known as epistaxis is very common. It typically has bimodal peaks. Which 2 of the following fit this?
1 - 1-5
2 - 2-10
3 - 30-50
4 - 50-80
2 - 2-10
4 - 50-80
Typically which group of blood vessels is responsible for epistaxis?
1 - cervical plexus
2 - kiesselbach’s plexus
3 - brachial plexus
4 - choroid plexus
2 - kiesselbach’s plexus
This is located in Littles area.
In the nose what is the most likely place for bleeding?
1 - woodruffs plexus
2 - kiesselbach’s plexus (littles area)
3 - greater palatine artery
4 - lateral crus
2 - kiesselbach’s plexus (littles area)
Remembers children can reach this area with their LITTLE fingers
Which of the following is NOT a common risk factor for nose bleeds locally?
1 - Nose picking
2 - Iatrogenic (following procedures)
3 - Colds/Sinusitis
4 - Hypertension
5 - Trauma
6 - Neoplastic
4 - Hypertension
ALWAYS CONSIDER NON ACCIDENTAL INJURY
Which of the following is NOT a common risk factor for nose bleeds systemically?
1 - Coagulation disorders
2 - Anticoagulant medication
3 - Hypertension
4 - Malignancy
5 - Medications
4 - Malignancy
Typically recognised as a local cause of nose bleeds
Is it typical for patients to vomit blood when they have had a nose bleed?
- no
Patients typically swallow blood and then bring this up
Are nose bleeds typically unilateral or bilateral?
- unilateral
Which of the following is typically performed as part of an assessment in a patient with epistaxis?
1 - FBC, Group and save and clotting
2 - Flexible nasendoscopy
3 - Oral cavity
4 - Anterior rhinoscopy
5 - all of the above
5 - all of the above
If a nose bleed is bilateral would does this suggest?
1 - coagulation disorder
2 - bleeding from the back of the nose
3 - tumour
4 - trauma
2 - bleeding from the back of the nose
Back of nose bleeding increases risk of aspiration of blood
If a nose bleed is prolonged, significant and/or recurrent, which 2 of the following could this suggest?
1 - thrombocytopenia
2 - trauma
3 - tumour
4 - clotting disorder
1 - thrombocytopenia
4 - clotting disorder
Both would require further testing
When advising a patient on how to manage a nose bleed, all of the following should be advised, EXCEPT which one?
1 - sit up
2 - tilt the head backwards
3 - squeeze the soft part of the nostrils together for 10 – 15 minutes
4 - spit out any blood in the mouth, rather than swallowing
5 - breathe through the mouth
2 - tilt the head backwards
Patients should tilt the head forwards so not to force blood into throat and increase risk of aspiration
Which of the following would prompt hospital admission or a trip to A&E?
1 - bleeding does not stop after 10 – 15 minutes
2 - nosebleed is severe
3 - bleeding is from both nostrils
4 - haemodynamically unstable patient
5 - all of the above
5 - all of the above
If a patient has ongoing bleeding that is coming from Little’s area/Kiesselbach’s plexus, which of the following could be used to treat this as first line?
1 - silver nitrate cautery
2 - nasal packs (non-absorbable vs absorbable)
3 - sphenopalatine artery ligation
4 - any of the above
1 - silver nitrate cautery
The other options are what could be done if the bleeding is severe and the source cannot be identified
1st = silver nitrate cautery
2nd = nasal packs
3 - sphenopalatine artery ligation
4 - radioembolic embolisation
All of the following are blood vessels supplying the nose, but which one accounts for 90% of the blood flow to the nose and is therefore the target for ligation if bleeding does not stop?
1 - anterior ethmoid artery
2 - posterior ethmoid artery
3 - greater palatine artery
4 - sphenopalatine artery
4 - sphenopalatine artery
Which 2 of the following are effective treatment options if a nose bleed does not stop?
1 - Nasal packing using nasal tampons or inflatable packs
2 - Nasal packing with tissue
3 - Nasal cautery using silver nitrate sticks
4 - Clopidogrel with aspirin
1 - Nasal packing using nasal tampons or inflatable packs
3 - Nasal cautery using silver nitrate sticks
- typically 1st choice
