Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ENT > Epistaxis > Flashcards

Epistaxis Flashcards

1
Q

List the 6 Sx related to conditions of the nose.

A
  1. Block: congestion vs total obstruction; uni vs bi
  2. Rhinorrhoea (runny nose)
  3. Rxn to irritation: itching, sneezing, pain
  4. Change in smell: decreased/absent, foul
  5. Facial pressure/pain
  6. Epistaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two classifications of epistaxis?

A
  1. Anterior epistaxis

2. Posterior epistaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most cases of epistaxis across all age groups are from ___ origin

A

80% are from anterior origin (Little’s area) from specifically the Kiesselbach’s plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Characteristics of anterior epistaxis

A
  • Originates from front of nose
  • Low volume
  • Unilateral in origin (start from one side but may come out both sides)
  • Do not tend to result in presentation to emergency care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Clinical presentation of anterior epistaxis

A
  • Nosebleed that is unilateral and low volume of blood

- High BP (anxiety)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Clinical presentation of posterior epistaxis

A
  • Nosebleed where it explodes bilaterally through nostrils and spitting copious amount of blood; sudden
  • Tachycardic
  • Hypotension in severe epistaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Posterior epistaxis most commonly occurs in _____

A

Elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why are posterior epistaxis most common in elderly?

A
  • Weakened blood vessels
  • Arteriolosclerosis
  • Elderly vascular paths
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of epistaxis

A

a. Idiopathic 90%
b. Local:
- Trauma
- Vascular causes
c. Systemic:
- anticoagulants
- coagulopathy
d. Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Explain how trauma can be a cause of epistaxis

A

a. Micro-mucosal trauma: picking nose, colds, dry air

b. Macro-mucosal trauma: hitting, MVA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Explain how vascular factors can be a cause of epistaxis

A

a. abnormal vessels (cancer)
b. increased blood flow to nose (i.e. not something wrong with blood)
c. infection
d. coughs + cold
e. hot days
f. increased periods of congestion: night time, changes with hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain how anticoagulants can be a cause of epistaxis

A
  • Secondary to drugs: aspirin, warfarin, alcohol, sildanifil, NSAIDs, clexane, NOACs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Explain how coagulopathies can be a cause of epistaxis

A
  • Haemophilia
  • von Willebrands disease
  • Thrombocytopaenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Explain how hypertension can be a cause of epistaxis

A

This is an indirect cause -> atherosclerosis -> nose bleeds. If BP suddenly rises it will not cause a nose bleed, but if you have a nose bleed whilst hypertensive it will bleed more profusely. It is a complication factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

DDx of epistaxis

A

Pseudoepistaxis must be rule out, as extranasal sites may stimulate epistaxis:

  • Pulmonary haemoptysis
  • Bleeding oesophageal varices
  • Tumour (pharynx, larynx, trachea)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ix of epistaxis

A
  • Hb and Ht
  • Platelet count
  • Coagulation studies
  • Cross match bloods
  • Blood urea and nitrogen
17
Q

Why would anaemia from epistaxis be normochromic and normocytic?

A

Hb is a concentration, therefore the of Hb per blood will remain the same. If we stop the bleeding and restore the volume, the pt will become anaemic that is normochromic and normocytic because normal RBC but in greater volume

18
Q

How would we replace fluids?

A

Crystalloid rather than colloid, and then give them blood.

What we replace what the patients is losing (taking into account risk) - if losing fluid replace with fluid, if losing blood replace with blood

19
Q

Px steps of the nose?

A 
General
Vital Signs
System Specific
- Anterior Rhinoscopy
- Nasoendoscopy
  1. External view: is their gross deviation?
  2. Nasal obstruction: block each nostril separately + ‘sniff in’
  3. Tilt tip
  4. Look in - thudicum speculum and pen torch
20
Q

What is the main Q asked before administering Rx to a patient?

A

Is the patient stable?
Are they at risk of becoming unstable?
(shock, tachycardic)

21
Q

What is the ABC of triage assessment and how does it relate to epistaxis?

A

Airway - can be compromised with nose bleed
Breathing - can be compromised with nose bleed
Circulation - what if something has changed? Always cycle back to A - whenever something changes in a resuscitation.

22
Q

What patient factors indicate a patient is at risk of becoming unstable?

A
  • Coagulopathy + anti-coagulation
  • Dehydrated - neglected and discovered by relative not sure how long they have been bleeding for
  • Extremes of age: the elderly and little children - less reserve will tolerate a low Hb and low volume poorly
  • The amount of blood and it not stopping - not slowing down - patient will meet a point where they can no longer compensate. Ongoing volume loss.
23
Q

What are the classes of haemorrhagic shock?

A

INSERT TABLE

24
Q

Non-pharmalogical Rx of epistaxis

A
  • Pinching lower cartilaginous part of nose for 10 mins; lean forward (do not lean back); cold compression on bridge of nose to stimulate vasoconstriction
  • avoid triggers: trauma, diet, exercise, sleep
  • saline rinsing, moisterisers to reduce dryness
25
Q

Acute Rx of epistaxis

A
  • Stimulate vasoconstriction: topical lignocaine with adrenaline
  • Cauterization
  • Nasal packing (nasal gauze, packs up and tamponades the bleed)
26
Q

Chronic Rx of epistaxis

A
  • Endoscopic cauterization

- Open surgery, radiation

27
Q

What is the ladder of intervention in epistaxis? ** important

A
  1. First Aid: local pressure (squeeze low and firm), calm down + sit down
  2. Modify risk factors: do not pick nose + air dryness
    Reassure the patient.
  3. Modify triggers
    What if still bleeding?
  4. Local pressure
  5. Get the blood pressure down - get patient to calm down and focus on their breathing. We can use pharmacological agents; calcium channel blockers, GTN not good as it is a vasodilator, give them a sedative (benzo or morphine) BUT drowsiness may not protect the airway = titrate dose.
  6. Vasoconstrictors
    a. Adrenaline = adrenergic agonist
    b. Cocaine = NA re uptake inhibition
    c. Phenylephrine + oxymetazoline: agonist alpha adrenergic receptors
    We can put them topically in combination. The advantage of cocaine is that it also numbs the nose
  7. Cautery
  8. Anterior packing
28
Q

What is von-Willebrands disease?

A

Binds platelets to each other, and to the damaged endothelial wall
Co-factor for Factor VIII.

29
Q

What are the typical features of coagulopathy?

A

INSERT TABLE

30
Q

List all the steps of managing a patient who presents to ED with epistaxis.

A

Conservative:
a. ask pt to pinch nares (or use two tongue depressors taped together if patient is unable to), lean forward
b. place ice pack on neck
c. place gauze ball with lignocaine solution (vasoconstriction)
Get Obvs - nb if HTN never treat, as this HTN is due to anxiety therefore treatment is treating the epistaxis

Rx:
a. Nasal pack: place nose tampon “rapid rhino” (soak in sterile water first - haemostatic agents activated). Insert with nose floor parallel to floor (head upright, normal). Can use head lamp to visualise. Can leave in for 24 hours.
If double packing (both nostrils) admit and observe as patients can have apnoea.
b. Prophylactic cephalexin (to prevent S. aureus TSS).
c. Consider cauterization

ENT (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions