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MD2 ENT > Epistaxis > Flashcards

Epistaxis Flashcards

1
Q

5 characteristics of anterior epistaxis

A 
From anterior nose
Usually unilateral
Lower volume bleed
Frequent, come and go
Most common
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2
Q

List 5 characteristics of posterior epistaxis

A 
From posterior nose - can taste blood
Bilateral from nostrils, also from mouth
Higher volume bleed
Most likely in elderly vasculopaths
Look shocked (tachycardiac, hypotensive)
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3
Q

List 2 local causes of epistaxis

A 
Mucosal trauma (macro and micro)
Vessels (increased blood flow, abnormality)
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4
Q

How does HTN cause epistaxis?

A

By leading to atherosclerosis

Is an exacerbating factor for epistaxis (will increase volume and duration of bleed)

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5
Q

List 3 reasons blood flow to the nose might be increased

A

Infection
Heat
At night

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6
Q

Why does blood flow to the nose increase at night?

A

Due to increased PNS drive

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7
Q

List 2 systemic causes of epistaxis

A

Atherosclerosis

Coagulopathy

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8
Q

Principles of resuscitation

A 
Airway (+ cervical spine)
Breathing
Circulation
Disability (i.e. neurological issues)
Everything else
(All can be relevant in the setting of epistaxis)
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9
Q

Why are elderly vasculopaths most likely to suffer a posterior epistaxis?

A

More fragile blood vessels due to atherosclerosis and arteriolosclerosis

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10
Q

Characteristics of class I haemorrhagic shock

A 
Lower volume
Normal HR
Normal BP
Normal pulse pressure
Normal RR
Normal UO
No CNS or mental state changes
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11
Q

Characteristics of class IV haemorrhagic shock

A 
High volume (>2L)
High or low HR
Low BP
Low pulse pressure
High RR
Very low or absent UO
Decreased mental state (otunded?)
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12
Q

Characteristics of class II haemorrhagic shock

A

Normal BP (compensating with HR)
Slightly increased RR
Normal UO
Anxiety (sympathetic drive)

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13
Q

Characteristics of class III haemorrhagic shock

A

Decreased UO

Agitated (sympathetic drive and other emotional factors)

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14
Q

List 6 relevant behavioural modification to treat epistaxis

A 
Avoid triggers (e.g. nose picking)
Diet
Exercise
Sleep
Environmental modification
Mood management
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15
Q

List 4 relevant non-pharmocological treatments for epistaxis

A

Hygiene measures
Moisturisers
Saline rinsing
Dietary supplements

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16
Q

Ladder of intervention

A

Local pressure
Get BP down (calm patient down, pharmacological interventions if required including Ca2+ channel blockers and sedatives - benzodiazepenes, morphine but ensure airway is protected; NOT GTN because venodilator will increase bleed)
Vasoconstrictors
Cautery
Anterior packing
Posterior packing
Surgical miracles (e.g. endoscopic, open, angiography)

17
Q

3 types of vasoconstrictors to treat epistaxis

A 
Adrenaline (a and B non-selective adrenergic agonist)
Cocaine HCl (LA: sodium channel block, NA reuptake inhibition; extra benefit due to numbing of nose)
Phenylephrine, oxymetazoline (a-adrenergic agonists)
18
Q

Do you ever use a posterior pack just by itself?

A

No - requires anterior pack

Also best to do both sides, front and back (bleed will probably be bilateral)

19
Q

Angiography

A

Multiple vessel ruptures

Telangiectasias (?Osler-Randall-Wavler syndrome, congenital condition)

20
Q

Von Willbrand disease

A

Presentation mimics platelet disorder not coagulopathy (unless no vWF, which is an AR inherited condition, in which case presents like thrombophilia as vWF carries FVIII around)

21
Q

Typical features of coagulopathies

A

Large bruising on trunk and limbs
Relatively slight bleeding from cuts
Nosebleeds and GI bleeds uncommon
Haematuria common
Haemarthrosis in severe haemophilia
Up to a day’s delay before bleeding after surgery or dental extraction
Very heavy menstrual periods?? (or platelet disorder?)

22
Q

Typical features of platelet disorders and von Willebrand’s disease

A

Lots of small bruises

23
Q

Investigations

A

FBE (may not reliable immediately post-epistaxis; will have low Hb a day after, or following resuscitation, due to restoration of volume without restoration of RBCs)
Clotting factors
U&E
Blood group, crossmatch (will initially give crystalloid not colloid, then transfusion once able)

24
Q

Dehydration

A

Loss of free water, nothing else

MD2 ENT (10 decks)

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