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Nose/Throat - Clinical Medicine IV > Epistaxis > Flashcards

Epistaxis Flashcards

1
Q

What region does this occur most from?

A

anterior Kiesselbach plexus

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2
Q

What is the presentation most often?

A

unilateral anterior nose

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3
Q

What are risk factors for this?

A

nasal trauma, dry node, HTN, nasal cocaine, ETOH, anticoag meds, atherosclerotic disease, rhinitis, deviated nasal septum, inhaled steroids

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4
Q

What do you think with posterior bleeding?

A

atherosclerotic disease and HTN

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5
Q

How does posterior bleeding present?

A

hemoptysis or hematemesis

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6
Q

How do you treat this?

A

direct pressure for 15 mins, leans forward

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7
Q

What are some pharm therapies?

A

phenylephrine for vasoconstriction, 4% cocaine,
topical decongestants - oxymetazoline or
topical anesthetics - tetracaine or lidocaine

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8
Q

What is the treatment for posterior bleeding?

A

ligation (internal maxillary or ethmoid or external cartoid)

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9
Q

What is acute hemorrhage from the nostril, nasal cavity, or nasopharynx?

A

epistaxis

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10
Q

What can epistaxis cause?

A

significant anxiety

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11
Q

What causes bleeding in posterior nose?

A

woodruff’s plexus - branches of sphenopalatine artery

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12
Q

Where is another area that a anterior nasal bleed can come from?

A

inferior turbinate

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13
Q

What can posterior packing cause?

A

airway compromise and respiratory depression, may lead to infection

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14
Q

What is the age range of epistaxis?

A

bimodal 2-10 and 50-80 year olds

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15
Q

Who does epistaxis occur most in?

A

males than females

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16
Q

What does recurrent episodes of epistaxis raise suspicion on?

A

significant nasal pathology

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17
Q

What medications can cause epistaxis?

A

NSAIDs, warfarin, heparin, ticlopidine, dipyridamole

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18
Q

What should you have the patient do before you look in their nose?

A

blow it, application of vasoconstrictor (oxymetazoline)

19
Q

What is the most common cause of epistaxis?

A

local trauma

20
Q

What should you do for significant hemorrhage epistaxis?

A

IV line and cystalloid infusion

21
Q

What vital sign will be higher with significant hemorrhage in epistaxis?

A

blood pressure

22
Q

What is a good way to rapidly control massive bleeding?

A

epistaxis balloon - Rhino-rocket

23
Q

What are some complications of epistaxis?

A

sinusitis, septal hematoma/perforation, external nasal deformity, mucosal pressure necrosis, vasovagal episodes, balloon migration, aspiration

24
Q

What is the process for using merocel for epistaxis?

A

trim sponge, moisten top with lube or ABX ointment, grasp sponge with bayonet, spread naris vertically move sponge in, once wet with blood it will expand to fill cavity

25
Q

How do you put in an epistaxis balloon?

A

cover with ABX or lube and inset along nasal cavity, inflate slowly with sterile water or air until stops

26
Q

Who get foreign bodies in their nose?

A

kids

27
Q

What is the most common thing found in nose?

A

jewelry beads then paper products and toys

28
Q

Who gets foreign bodies more?

A

males

29
Q

What age has the highest incidence of nasal FB?

A

2-5 yo, develop pincer grip at 9 mo

30
Q

What side does foreign body occur most?

A

right sided 2x more than left

31
Q

Where do FB lodge?

A

anterior to middle turbinates or below inferior turbinate

32
Q

What is the number one presentation of FB?

A

unilateral nasal discharge

33
Q

What are the other common clinical manifestations of nasal FB?

A

nasal irritation, epistaxis, sneezing, snoring, sinusitis, stridor, wheezing, fever of unknown origin

34
Q

What is a FB that is super dangerous?

A

metallic button batteries

35
Q

What causes the damage in nose batteries?

A

electrical currents - release of sodium hydroxide and chlorine gas

36
Q

What do you do for nose batteries?

A

DO NOT IRRIGATE NASAL CAVITY

37
Q

What are some complications of Nasal FB?

A

acute otitis media and sinusitis due to delay dx

38
Q

How are organic foreign bodies different from non organic?

A

OFB cause swell and more symptomatic

39
Q

Was is the first type of cautery you use?

A

silver nitrate

40
Q

What do you do if silver nitrate fails?

A

pack em

41
Q

What is traditional nasal packing?

A

using bayonet forceps to slowly add in gauze btw inferior turbinate and septum

42
Q

What is important to know about the balloon?

A

know how much water you put in

43
Q

When do you tell them to go to the ER?

A

20 mins of pressure but still bleeding

Nose/Throat - Clinical Medicine IV (12 decks)

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