Epistaxis

Question 1

What region does this occur most from?

Answer 1

anterior Kiesselbach plexus

Question 2

What is the presentation most often?

Answer 2

unilateral anterior nose

Question 3

What are risk factors for this?

Answer 3

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

Question 4

What do you think with posterior bleeding?

Answer 4

atherosclerotic disease and HTN

Question 5

How does posterior bleeding present?

Answer 5

hemoptysis or hematemesis

Question 6

How do you treat this?

Answer 6

direct pressure for 15 mins, leans forward

Question 7

What are some pharm therapies?

Answer 7

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

Question 8

What is the treatment for posterior bleeding?

Answer 8

ligation (internal maxillary or ethmoid or external cartoid)

Question 9

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

Answer 9

epistaxis

Question 10

What can epistaxis cause?

Answer 10

significant anxiety

Question 11

What causes bleeding in posterior nose?

Answer 11

woodruff’s plexus - branches of sphenopalatine artery

Question 12

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

Answer 12

inferior turbinate

Question 13

What can posterior packing cause?

Answer 13

airway compromise and respiratory depression, may lead to infection

Question 14

What is the age range of epistaxis?

Answer 14

bimodal 2-10 and 50-80 year olds

Question 15

Who does epistaxis occur most in?

Answer 15

males than females

Question 16

What does recurrent episodes of epistaxis raise suspicion on?

Answer 16

significant nasal pathology

Question 17

What medications can cause epistaxis?

Answer 17

NSAIDs, warfarin, heparin, ticlopidine, dipyridamole

Question 18

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

Answer 18

blow it, application of vasoconstrictor (oxymetazoline)

Question 19

What is the most common cause of epistaxis?

Answer 19

local trauma

Question 20

What should you do for significant hemorrhage epistaxis?

Answer 20

IV line and cystalloid infusion

Question 21

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

Answer 21

blood pressure

Question 22

What is a good way to rapidly control massive bleeding?

Answer 22

epistaxis balloon - Rhino-rocket

Question 23

What are some complications of epistaxis?

Answer 23

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

Question 24

What is the process for using merocel for epistaxis?

Answer 24

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

Question 25

How do you put in an epistaxis balloon?

Answer 25

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

Question 26

Who get foreign bodies in their nose?

Answer 26

kids

Question 27

What is the most common thing found in nose?

Answer 27

jewelry beads then paper products and toys

Question 28

Who gets foreign bodies more?

Answer 28

males

Question 29

What age has the highest incidence of nasal FB?

Answer 29

2-5 yo, develop pincer grip at 9 mo

Question 30

What side does foreign body occur most?

Answer 30

right sided 2x more than left

Question 31

Where do FB lodge?

Answer 31

anterior to middle turbinates or below inferior turbinate

Question 32

What is the number one presentation of FB?

Answer 32

unilateral nasal discharge

Question 33

What are the other common clinical manifestations of nasal FB?

Answer 33

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

Question 34

What is a FB that is super dangerous?

Answer 34

metallic button batteries

Question 35

What causes the damage in nose batteries?

Answer 35

electrical currents - release of sodium hydroxide and chlorine gas

Question 36

What do you do for nose batteries?

Answer 36

DO NOT IRRIGATE NASAL CAVITY

Question 37

What are some complications of Nasal FB?

Answer 37

acute otitis media and sinusitis due to delay dx

Question 38

How are organic foreign bodies different from non organic?

Answer 38

OFB cause swell and more symptomatic

Question 39

Was is the first type of cautery you use?

Answer 39

silver nitrate

Question 40

What do you do if silver nitrate fails?

Answer 40

pack em

Question 41

What is traditional nasal packing?

Answer 41

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

Question 42

What is important to know about the balloon?

Answer 42

know how much water you put in

Question 43

When do you tell them to go to the ER?

Answer 43

20 mins of pressure but still bleeding