Epistaxis Flashcards
What is epistaxis?
Bleeding from the nose
What are the causes of epistaxis in children?
Trauma - nose picking, sneezing, injury to the nose
Mucosal irritation - URTIs, dry air, steroid use
Coagulation disorder - von Willebrand, hereditary haemorrhagic telangiectasia
Juvenile nasal angiofibroma
Nasal polyp
Where is bleeding from the nose most commonly from?
Littles area
Where is Littles area?
Anterior septum bilaterally
Which vessels form Littles area?
Confluence of blood vessels from Internal carotid arteries - Anterior and posterior ethmoidal
and External carotid arteries - greater palatine, sphenopalatine, superior labial and lateral nasal arteries
Who is juvenile nasal angiofibroma most commonly seen in?
Males ages 12-20
List the risk factors for epistaxis
Activities involving altitude Strenuous physical activity Raised ICP Coagulopathy Hay fever/recurrent URTI Medication use - rare - mostly in anti-coagulated adults
Describe the examination of epistaxis
May be able to see the source on anterior septum
Examine for evidence of septal haematoma
What might septal haematoma cause
Permanent disfiguration
How is septal haematoma managed
ENT review and drainage
Give a differential for epistaxis
Foreign body
What investigations can be done for epistaxis?
If big/recurrent bleed difficult to stop then FBC and clotting profile
Flexible nasal endoscopy to rule out JNA or polyps
Describe the initial first aid for epistaxis
Lean forward Pinch the soft part of nose for 15 mins Reassure child Check bleeding stopped if not then another 15 mins and get child to suck on ice or apply ice to forehead If not stopped then GP/A&E
Describe the management of epistaxis in A&E
Look for bleeding source
Nasal cautery with silver nitrate - circular motion for 15 seconds
ENT- anterior or posterior nasal pack
Nasal injury - reduction of nasal fractures
FBC and clotting - discussion with haem if recurrent
What are the risks of silver nitrate nasal cautery
Septal perforation
Failure
Pain
