Epistaxsis

Question 1

what are they split into

Answer 1

anterior bleeds

posterior bleeds

Question 2

what is the source of bleeding usually in anterior bleeds

Answer 2

Kiesselbach’s plexus - network of capillaries

Question 3

what is the source of bleeding for posterior bleeds

Answer 3

on the other hand, tend to be more profuse and originate from deeper structures.

Question 4

age affected by posterior bleeds and what does it risk compromising

Answer 4

older patients and confer a higher risk of aspiration and airway compromise.

Question 5

causes

Answer 5

Exacerbation factors include:
nose picking
nose blowing

trauma to the nose

insertion of foreign bodies

bleeding disorders
immune thrombocytopenia
Waldenstrom’s macroglobulinaemia

juvenile angiofibroma
benign tumour that is highly vascularised
seen in adolescent males

cocaine use
the nasal septum may look abraded or atrophied, inquire about drug use. This is because inhaled cocaine
cocaine is a powerful vasoconstrictor and repeated use may result in obliteration of the septum.

hereditary haemorrhagic telangiectasia

granulomatosis with polyangiitis

Question 6

Mx if patient is haemodynamically stable

Answer 6

Asking the patient to sit with their torso forward and their mouth open
avoid lying down unless they feel faint
his decreases blood flow to the nasopharynx and allows the patient to spit out any blood in their mouth
it also reduces the risk of aspirating blood
Pinch the cartilaginous (soft) area of the nose firmly
this should be done for at least 20 minutes
also ask the patient to breathe through their mouth.

Question 7

if bleeding does not stop after 10-15mins of continuous pressure Mx

Answer 7

cautery or packing

Question 8

epistaxis that has failed emergency mx

Answer 8

sphenopalatine ligation in theatre