Epistaxis

Question 1

Kiesselbach plexus/ little area

Answer 1

• sphenopalatine artery
• greater palatine artery
• septal branch of sup labial a
• ant ethmoidal arteries

Question 2

Epidemiology of epistaxis

Answer 2

Anterior epistaxis: children and young adults

Post epistaxis: older age group

*most epistaxis originate from little’s area

Question 3

Causes of epistaxis

Answer 3

Local: idiopathic, congenital, infective, trauma

Systemic: coagulopathies, thrombocytopenia

Question 4

Mx

Answer 4

Initial mx
- trotters manouver: apply pressure to nasal alae and icepack to forehead
- dont release pressure of nasal alae for 10 mins
- should sit up with body titled forwards
- ensure blood not swallowed
- +/- apply decongestant/anaesthetic agents intranasally
- if site of bleeding identified, cauterize with TCA or silver nitrate

Post nasal packing
- if despite ant nasal packing, bleeding persists check posterior
- foleys catheter or epistaxis balloon
- post packing gauze

If no bleeding for 24h, arrange for nasoendoscopy

If rebleed, repack
- EUA and sphenopalatine clipping

• if SPA ligation fail
  
  • ligate of int maxillary artery or ext carotid artery
  • angiography +/- embolization