Epistaxis - covered in ENT Flashcards
What is epistaxis?
Epistaxis, or nose bleeds, is divided into anterior and posterior bleeds. Anterior bleeds often have a visible source and occur due to damage to Kiesselbach’s plexus, while posterior bleeds are more profuse and originate from deeper structures.
What are common causes of epistaxis?
Common causes include nose picking, nose blowing, trauma, foreign bodies, bleeding disorders, cocaine use, and hereditary conditions.
Examples: Immune thrombocytopenia, Waldenstrom’s macroglobulinaemia, juvenile angiofibroma.
What is the management for stable patients with epistaxis?
For stable patients, first aid measures include sitting forward, pinching the nose for at least 20 minutes, and breathing through the mouth.
What should be done if first aid measures are successful?
Consider using a topical antiseptic like Naseptin to reduce crusting, unless the patient has allergies. Mupirocin is an alternative.
When should a patient be admitted for epistaxis?
Admission is considered if there are comorbidities, suspected underlying causes, or if the patient is under 2 years old.
What self-care advice should be given to patients after an epistaxis?
Patients should avoid blowing or picking the nose, heavy lifting, exercise, lying flat, and consuming alcohol or hot drinks.
What to do if bleeding does not stop after 10-15 minutes?
If bleeding persists, consider cautery or packing. Cautery is preferred if the source is visible and tolerated.
How is cautery performed for epistaxis?
Use a topical local anaesthetic, wait 3-4 minutes, identify the bleeding point, and apply silver nitrate for 3-10 seconds. Avoid unnecessary treatment areas.
Cauterise only one side of the septum to prevent perforation.
What should be done if cautery is not viable?
If cautery is not viable, packing may be used. Anaesthetise the area, pack the nose while the patient is sitting forward, and monitor for continued bleeding.
What is the protocol for haemodynamically unstable patients with epistaxis?
Haemodynamically unstable patients should be admitted to the emergency department and managed with first aid measures in the interim.
What should be done for epistaxis that fails all emergency management?
Sphenopalatine ligation in theatre may be required for cases that do not respond to emergency management.
